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BOOKS BY EMILY A. M. STONEY 



Practical Points in Nursing 
i2mo of 500 pages, illustrated. Cloth, 

^1.75 net. Fourth Edition 



Materia Medica for Nurses 

i2mo of 306 pages. Cloth, ^^1.50 net. 

Third Edition 



Bacteriology and Surgical Technic for Nurses 
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Bacteriology 



AND 



Surgical Technic 
For Nurses 



BY 

EMILY M. A. STONEY 

Superintendent of the Training School for Nurses, St. Anthony's Hospital, Rock 

Island, 111. ; Author of " Practical Points in Nursing," " Practical 

Materia Medica for Nurses, ' etc. 

Third Edition/ Thoroughly Revised and Enlarged 
BY 

Frederic Richardson Griffith, m.d, (Univ. of Penn.) 

OF New York 
Surgeon, Fellow of the New York Academy of Medicine 



"Every bit of knowledge that we cannot use for the uplifting of our physical, 
intellectual, or emotional life is so 7nnch rvaste of ti7ne and labor. Everything taught 
is worth the knoiving, but not ivorth the putting away in the pigeon-holes of memory^ 
to be recalled some day by accident." 



ILLUSTRATED 

PHILADELPHIA AND LONDON 

W. B. SAUNDERS COMPANY 

J9J0 



4 r% 



Copyright, 1900, by W. B. Saunders and Company. Set up, electrotyped, printed, 
and copyrighted September, 1900. Reprinted September, 1902. Revised, 
reprinted, and recopyrighted January, 1905. Reprinted March, 
1906, November, 1907, February, 1909, and August, 1909. Re- 
vised, reprinted, and recopyrighted September, 1910. 



Copyright, 1910, by W. B. Saunders Company, 



PRINTED IN AMERICA 



PRESS OP 

W. B. SAUNDERS COMPANY 

PHILADELPHIA 



©CLA273y 



TO 



DR. JOHN R. SLATTERY 

THIS VOLUME IS DEDICATED BY THE AUTHOR 

IN GRATEFUL REMEMBRANCE OF MUCH ENCOURAGE^ 
MENT AND PERSONAL KINDNESS 



PREFACE TO THE THIRD EDITION, 



The chief concern in producing the present edi- 
tion has been to use plain and simple language to 
teach the surgical nurse to be clean, reliable, suc- 
cessful in her work. 

Some well-tried diet recipes have been added, and 

special operations have been considered a little more 

fully ; and meanings of all the hard words used in 

the text, it is believed, have been explained in the 

Glossary. 

Frederic Richardson Griffith. 

New York, September, 1910. 

1 



PREFACE. 



The following pages constitute the notes of a series 
of lectures on ' ' Bacteriology and Surgical Tech- 
nic " which followed closely upon my lectures on 
' ' Materia Medica. ' ' The first part of the book is de- 
voted to Bacteriology and Antiseptics ; the second 
part to Surgical Technic, Signs of Death, Au- 
topsies. 

No attempt has been made to write a complete 
treatise on bacteriology, but merely to outline and 
simplify that branch for nurses. 

It was deemed advisable to add the chapter on 
* ' Signs of Death and Autopsies, ' ' as many nurses 
are unacquainted with the preparations for an autopsy 
in private practice. 

So many changes have taken place in surgery since 
the lectures were delivered that it has been necessary 
to rewrite many of the chapters. In this I was 
assisted by Dr. A. S. Allen and by Professors J. B. 
Murphy, Christian Fenger, and Joseph L. Miller, of 
the Northwestern University Medical College. I am 
glad of this opportunity to thank them for their 
assistance. 

3 



4 PREFACE, 

Free use has been made of the works on bac- 
teriology by McFarland, Crookshank, and Woodhead; 
of "Aseptic Surgical Technique," by Dr. Hunter 
Robb ; "Operative Gynecology," by Dr. Howard A. 
Kelly; and "Aseptic Treatment of Wounds," by 
Dr. C. Schimmelbusch. 

I am unable to express my indebtedness to Dr. 
Joseph P. Comegys for his valuable assistance. with 
the manuscript and its preparation for the press. 

I wish also to thank Drs. George L. Eyster and 
Charles C. Carter for their friendly help and interest 
in the work. 

e:mii.y M. ARMSTRONG-STONEY. 



CONTENTS. 



PART L-BACTERIOLOGY; ANTISEPTICS. 



CHAPTER I. 

PAGE 

History of Bacteriology 9 

CHAPTER n. 
Bacteria as the Causes of Disease 21 

CHAPTER III. 
The Theory of Antitoxins 37- 

CHAPTER IV. 
Antiseptics, Disinfectants, and Deodorants 44 

CHAPTER V. 
Antiseptics (continued) 58 



PART n.— SURGICAL TECHNIC 



CHAPTER VI. 

Bandaging aind Dressings 66 

5 



6 CONTENTS. 

CHAPTER VIT. 

PAGE 

Care of Operating-room; Methods of Sterilization; Care 
OF Instruments 86 

CHAPTER VHI. 

Instruments Necessary in Different Operations; Keeping 
OF Charts ; Surgeon's Kit, etc 97 

CHAPTER IX. 
Anesthesia 130 

CHAPTER X. 

ANTishPTic Gauzes, Tampons, Thkrmocautery, Saline Infu- 
sions, Irrigation, etc 147 

CHAPTER XI. 

Sutures and Ligatures ; Sponges ; Drainage ; Drainage- 
tubes ; Gauze Drains; Rubber Dam; Rubber and Cotton 
Gloves 157 

CHAPTER XII. 
Inflammation 173 

CHAPTER Xni. 

Catheterization ; Douches ; Enemata ; Washing out the 

Bladder; Lavage 176 

CHAPTER XIV. 
Minor Surgical Procedures • • 186 

CHAPTER XV. 
Obstetrical Nursing; Care of Infants, etc 197 

CHAPTER XVI. 

Operations; Preparation of the Operating-room ; The Sur- 
geon AND His Assistants 203 



CONTENTS. 7 

CHAPTER XVII. 

PAGE 

Transportation ; Preparation of Patient For Operation ; 

Care of Patient during and after Operation .... 212 

CHAPTER XVIII. 

Sequelae of Operations ; Shock, Hemorrhage, Septic Peri- 
tonitis, Accidents during Operations, etc. , 227 

CHAPTER XIX. 
Special Operations 239 

CHAPTER XX. 
Operations in Private Practice • 243 

CHAPTER XXI. 
Gynecologic Examinations and Operations 254 

CHAPTER XXII. 
Diet Recipes 26^ 

CHAPTER XXIII. 

Signs of Death ; Autopsies 272 

CHAPTER XXIV. 

Hygiene; Personal Conduct of a Nurse's Life; of the Re- 
wards ; Success 278 

Glossary 285 

Index 297 



PART I. 
BACTERIOLOGY ; ANTISEPTICS. 



CHAPTER I. 
HISTORY OF BACTERIOLOGY. 

The eye is one of the most beautiful and delicately 
contrived organs in the body, and yet its vision un- 
aided is very limited in its scope. We see so much 
that we rarely stop to think of what an enormous 
world exists in and all about us which we cannot see 
at all — a world peopled by organisms so very small 
that they can be seen and studied only by the aid of 
the most powerful magnifying lenses, and so num- 
erous that they are quite beyond any calculation. 

Bacteria exist nearly everywhere; they are almost 
universal, except that they are not found deep down 
in the ground nor high up in the air. They and their 
spores, or seeds, float in the air we breathe, swim in the 
water we drink, grow upon the food we eat, and lux- 
uriate in the soil beneath our feet. Wherever man, 
animals, and plants live, die, and decompose, bacteria 
are sure to be present. The surface of the body never 
escapes their establishment, and so deeply are some 
individuals situated beneath the epithelial cells that 
the most vigorous scrubbing and washing and the use 



lO BACTERIOLOG V. 

of powerful disinfectants are necessary to remove them 
from the surgeon's hands. 

The mouth is said to be always replete with them; 
and, since many are swallowed, the digestive tract 
always contains them. The germ of pneumonia, for 
instance, is said to be habitually present in the mouth 
of almost every healthy person; consequently, its 
entrance into the lungs is only a matter of accident. 

The existence of these bacteria has been known for 
many years, but it is only during the past few decades 
that any great advancement in our knowledge of them 
has been made. 

Over two hundred years ago a man named Athana- 
sius Kircher, a German, mistook blood-corpuscles 
and pus-corpuscles (leukocytes) for small worms, and 
built up a new theory of the causes of disease and 
putrefaction upon this basis. At the same time. 
Christian Ivange, a professor in the medical school at 
lycipzig, expressed his opinion that the rash that 
appeared on the skin in the eruptive fevers, etc., 
was the result of putrefaction conveyed by small liv- 
ing worms in the body. Shortly after these obser- 
vations came those of Anthony van Leeuwenhoek, 
a native of Delft, in Holland, who, in his early years, 
had learned the art of polishing lenses, and who was 
able, ultimately, to produce the first really good 
microscope that had yet been constructed. He saw, 
and described with astonishing clearness, various 
forms of bacteria found in the material taken from 
the mouth of an old man who never cleaned his 
teeth. He gave an accurate description of the rod- 
shaped bacteria, motile and motionless ; now called 
bacilli ; of the spiral threads, or spirilla ; and of 



HISTOR V OF BA CTERIOL OGY. II 

rounded micro-organisms, or micrococci. Although 
he did not attempt to theorize as to the meaning of 
these organisms at the time, later on, in 1713, after 
finding similar organisms in the greenish pellicle 
formed on the surface of the water in an aquarium, 
he came to the conclusion that the various forms of 
bacteria found in the material scraped from the teeth 
found their way into the mouth through the medium 
of the drinking-water that had been stored in barrels, 
and that some of these found there a nidus in which 
they multiplied. 

This was the real beginning of bacteriology; and 
from this origin the study advanced with considerable 
rapidity in spite of ridicule and much opposition. 
Various opinions regarding the connection of these 
germs with disease and putrefaction, were put for- 
ward; but it was not until 1831 that any important 
advance was made in our knowledge of this connec- 
tion. Previous to that time a large mass of facts in 
regard to these little living organisms was being 
gradually accumulated, and fresh discoveries were 
constantly made by various workers; but since no 
systematic attempts to classify the newly observed 
facts were made, the scientific results were very small. 

The first real advance made in our knowledge of 
the presence of a living contagious element in the 
production of disease and fermentations was made 
by Frederick Miiller, of Copenhagen, and was the 
result of a systematic attempt to arrange the knowl- 
edge which had been accumulated during all those 
years. From that time to the present, the science 
has made great strides ; so that we have now an 
accurate knowledge of the bacteria which cause a 



12 BACTERIOLOGY. 

number of different diseases. The knowledge of 
methods and details of work is now so general that 
the science of bacteriology is rapidly growing, and 
has revolutionized already very many branches of 
medicine. 

In 1840, Henle was led to believe that the cause of 
miasmatic, infective, and contagious diseases must be 
looked for in living fungi, or other minute living 
organisms. Unfortunately, at that time the methods 
of study employed prevented him from demonstrating 
the accuracy of his belief It was left for Pasteur and 
Koch to complete the work. Davaine, in 1848, was 
the first to see and to recognize disease-producing 
bacteria — he saw anthrax-bacilli in the blood of sheep 
dead of splenic fever. 

Pasteur then took up the work; and in 1857 ^^^ 
faultless demonstration of the germ-theory of disease 
was brought out as a result of his experiments on fer- 
mentation and putrefaction, and on the bacteria of 
wine and those of the silkworm. He showed that the 
acetic fermentation, viscosity, bitterness, and turning 
flat of wines are due to the action of certain organized 
ferments, and demonstrated a causal relation between 
certain lowly-organized parasitic organisms and spe- 
cial diseases in animals and insects. Upon Pasteur's 
observations Lord Lister based his successful system 
of the treatment of wounds, known as "antiseptic 
surgery. ' ' 

We all know of the wonderful success which now 
marks the operations of major surgery, and of the 
daring boldness of operators who attempt what was 
utterly impossible as long as antiseptic surgery was 
unknown. Lister, accepting the truth of Pasteur's 



HISTORY OF BACTERIOLOGY. 1 3 

statement — that germs are the producers of fermenta- 
tions — concluded that germs entering wounds from the 
outside might be the cause of suppuration; and since 
germs are always and everywhere floating in the air, 
suspended in water, and attached to the surgical in- 
struments, dressings, and sponges used in operations, 
he judged correctly that it was highly advantageous 
to employ an antiseptic agent in order to kill any of the 
suspended or adherent organisms before any materials 
could be allowed to come in contact with wounded 
tissues; consequently, the hands of the operator and 
his assistants, the surgical instruments, sponges, dress- 
ings, sutures and ligatures, were kept constantly satu- 
rated with a solution of carbolic acid (i : 40), and the 
operation was performed under a spray of carbolic acid 
(i : 20). Carbolized dressings were used ; and if the 
discharge was profuse, the dressings were changed 
once in twenty-four hours under a constant use of the 
spray. The researches of a later date have shown, how- 
ever, not only that the atmosphere cannot be disin- 
fected, but also that the air of ordinarily quiet rooms, 
while containing the spores of numerous saprophytic 
organisms, rarely contains many pathogenic bacteria. 
We also know that a direct stream of air, such as is 
generated by an atomizer, causes more bacteria to be 
conveyed into a wound than ordinarily would fall 
upon it, thereby increasing instead of lessening the 
danger of infection. Lister, we must remember, was 
not the discoverer of carbolic acid nor of the fact that 
it would kill bacteria; but, convinced that inflamma- 
tion and suppuration were caused by the entrance of 
germs from the air, instruments, sponges, and dress- 
ings, into wounds, he suggested the antisepsis which 



14 BACTERIOLOGY. 

would result from the use of sterile instruments, clean 
hands, dressings, towels, and the like; and made ap- 
plications intended to keep the surface of the wound 
moistened with a germicidal solution in order to kill 
such germs as might accidentally enter. He also 
introduced the practice of concluding operations by 
the application of a protective dressing, such as would 
tend to preclude the entrance of germs at a sub- 
Sequent period. This procedure defeats its purpose 
for usefulness by reason of the moisture retained acting 
as a direct growth medium for those bacteria already 
upon or in the skin. Listerism has spread slowly but 
surely to all the departments of surgery and obstetrics. 

Since Lister's treatment was first inaugurated, 
many details of its application have been variously 
modified and great additions to our knowledge have 
been made. In bacteriology much important work 
has been done, and great advances are being con- 
stantly made. There are a number of diseases, each 
one of which has been definitely proved to be caused 
by a germ of its own, a germ which causes no other 
disease. There is also a list of diseases in which the 
proof is not yet conclusive, but for which the proba- 
bility is that a specific germ will be found. The 
following data have been gathered chiefly from the 
works of McFarland and Woodhead. 

In 1845, Langenbeck discovered that the specific 
disease of cattle known as actinomycosis could be 
communicated to man. His observations, however, 
were not given to the world until 1878, one year 
after Bollinger had discovered the cause of the 
disease in animals. 

In 1847, SemmelweiSj on the basis of his own 



HISTORY OF BACTERIOLOGY. 1 5 

observations, formulated the precept that puerperal 
fever is the result of the introduction of organic 
ferments into the puerperal genital tract. This dis- 
covery, established by himself and confirmed by the 
observations of many others, marked an era in ob- 
stetrics. The organic ferments have since been 
identified as specific bacteria. Semmelweis, in this 
way, anticipated in practical antisepsis the discover- 
ies of Lister and Pasteur; while the late Oliver Wen- 
dell Holmes, in a paper entitled " Puerperal Fever a 
Private Pestilence," published in 1843, ^^^ repub- 
lished in 1855, i^ treating of its prophylaxis, an- 
ticipated the teaching of Semmelweis. Semmel\veis 
was first led to recognize the source of puerperal in- 
fection by the case of Prof. Koletschka, of the 
University of Vienna, who, having received a dis- 
section-wound, became thereby fatally infected. In 
consequence of this, Semmelweis concluded that 
there was an identity between this infection and that 
of which so many hundreds of puerperal women 
died. In the school for instruction in practical ob- 
stetrics, with which he was connected, there were 
two departments, one for medical students, the other 
for midwives; the students going as a rule directly 
to the obstetric ward from the autopsy-room. He 
first noted the much greater mortality in the stu- 
dents^ ward, and in May, 1847, began to require the 
students to wash their hands in chlorin- water before 
making vaginal examinations, thereby reducing the 
puerperal mortality to a point lower than had been 
ever before reached. 

In 1863, Davaine established by experiments the 
bacterial nature of splenic fever, or anthrax. 



1 6 BA CTERIOL OGY. 

In 1869, the first complete study of a contagious 
affection was made by Pasteur, in two diseases affect- 
ing silkworms — pebrine and flacherie— which he 
showed to be due to micro-organisms. 

In 1875, Koch described more fully the anthrax- 
bacillus, gave a description of its spores and the 
properties of the same, and was enabled to cultivate 
the germ on artificial media; and, to complete the 
chain of evidence, Pasteur and his pupils supplied 
the last link by reproducing the same disease in 
animals by artificial inoculation from pure cultures. 
The study of the bacterial nature of anthrax has been 
the basis of our knowledge of all contagious mala- 
dies; and most advances in tecbnic have been made 
first through the study of the bacillus of that disease. 

In 1879, Hansen announced the discovery of bacilli 
in the cells of leprous nodules. They were subse- 
quently clearly described by Neisser. From the 
nature of the symptoms and from the course of the 
disease, leprosy up to this time was long considered 
to be a disease similar to tuberculosis, and the dis- 
covery of the bacillus paved the way for the recep- 
tion of Koch's discovery of the tubercle-bacillus. 

In the same year Neisser discovered the gonococ- 
cus to be the specific cause of gonorrhea. 

In 1880, the bacillus of typhoid fever was first 
observed by Eberth, and independently by Koch. 

In 1880, Pasteur published his work upon 
** chicken-cholera," an epidemic disease which afiects 
turkeys, pigeons, chickens, ducks, and geese, and 
which causes almost as much destruction among 
them as the occasional epidemics of cholera and 
small-pox produce among man. 



HISTORY OF BACTERIOLOGY. 1/ 

In the same year Sternberg described the pneumo- 
coccus, calling it "Micrococcus Pasteuri," which he 
secured from his own saliva; and in the same year 
Pasteur also found the same organism in saliva; 
though it is to Fraenkel, Talamon, and particularly 
Weichselbaum, that we are indebted for the dis- 
covery of the relation which the organism bears to 
pneumonia. 

In 1882, Robert Koch made himself immortal by 
the discovery of and work upon the bacillus of tuber- 
culosis, one of the most dreadful, and unfortunately 
most common, diseases of mankind. While great 
men of the earlier days of pathology clearly saw that 
the time must come when the parasitic nature of this 
disease would be proved, and some, as Klebs, Ville- 
min, and Cohnheim, were "within an ace" of the 
discovery, it remained for Koch to succeed in dem- 
onstrating and isolating the specific bacillus, and to 
write so accurate a description of the organism and 
the lesions it produces as to render the discovery one 
of the most complete ever made in the history of 
medical science. 

In the same year Loeffler and Schiitz reported the 
discovery of the bacillus of glanders, an infectious 
disease almost confined to certain of the lower ani- 
mals; although occasionally persons whose habitual 
association with and experimentation upon animals 
bring them into frequent contact with such as are 
diseased, have become accidentally infected. 

In 1884, Koch discovered the "comma-bacillus," 
the cause of cholera. 

In the same year Loeffler discovered the diphthe- 
ria-bacillus, and Nicolaier that of tetanus. 



1 8 BACTERIOLOGY. 

On October 26, 1885, Pasteur made the first ap- 
plication of his method for the treatment of hydro- 
phobia, nearly ten years before the time we began to 
understand the production and use of antitoxins in 
human medicine. 

In 1890, Koch issued to medical men what is 
known as tuberculin, a brownish, syrup-like fluid 
used experimentally in the diagnosis of tubercu- 
losis. 

In 1892, Canon and Pfeiffer discovered the bacillus 
of influenza. 

In the same year Canon and Pielicke first found a 
bacillus now thought to be the specific cause of 
measles. 

In 1894, Yersin and Kitasato independently iso- 
lated the bacillus causing the bubonic plague then 
prevalent at Hong-Kong, and now threatening 
Europe. 

Sanarelli, in 1896, reported the discovery of the 
micro-organism of yellow fever. His conclusions 
were based on the presence of a certain germ (Bacil- 
lus icteroides) in 58 per cent, of cases examined, and 
the production of symptoms and pathologic changes 
in the lower animals resemble those present in 
man. Sanarelli' s observations have been confirmed 
by a commission of the U. S. Marine-Hospital Ser- 
vice. Some doubt has lately been thrown upon this 
germ being the specific cause of yellow fever. How- 
ever, the mode of transfer of the disease from sick to 
well persons has been proved. Mosquitoes, it is now 
known, act as the disseminators of yellow fever. The 
females of the species called Stegomyia fasciata, twelve 
days after biting an individual sick of yellow fever, act 



HISTORY OF BACTERIOLOGY: 1 9 

the role of carrier for several months' time thereafter. 
This mosquito is prone to inhabit thickly populated 
districts rather than the open country, its presence and 
multiplication depending upon the continuance of 
stagnant ^Yater. It is most active between the hours 
of 4 p. M. and midnight, and ceases to bite when the 
temperature falls below 62° F. This last fact bearing 
out the long-known observation that the first frost 
killed the fever, no ncAV cases developing after^^ard 
in a given district liable to extremes of temperature. 
Preventive measures call for the destruction of all the 
mosquitoes in the house of a patient taken with the 
disease, best accomplished by closing up and screen- 
ing all the doors and windows of the premises and 
burning sulphur (i pound of roll sulphur to every 
1000 cubic feet of room space). Screening of the 
patient, sick or dead, must be carried out for the com- 
mon protection. Spirits of camphor, oil of penny- 
royal, or 5 per cent, menthol ointment applied fre- 
quently to exposed parts of the body — neck, face, 
wrists, and ankles — may be employed to keep off the 
mosquitoes in the non-immune. 

Epidemic cerebrospinal meningitis, or spotted 
fever, is now known to be caused by a specific germ 
present in the cerebrospinal fiuid of patients suffer- 
inof from this disease. The route of infection is not 
fully determined, but it is probably through the nose. 

Malta-fever, a disease of the IMediterranean islands, 
and occasionally of the Antilles and Central and 
South America, is due to a micrococcus discovered 
by Bruce, and called Bacillus melitensis. 

^lalarial fever is an infectious disease ; but, unlike 
those mentioned, it is not caused by a vegetable germ, 



20 BACTERIOLOGY. 

a bacterium, but by a microscopic animal, the Plasmo^ 
diMfn malaricE^ which is found in the blood of the 
afflicted individual, its entrance being brought about 
by the stings of mosquitoes (females of certain 
varieties). 

There is some grounds for a belief that maliofnant 
tumors — cancers and sarcomas — are due to micro- 
organisms. The nature of the parasite is as yet un- 
known ; but the latest researches point to a tiny 
organism, a yeast-plant or blastomycete. 



CHAPTER II. 
BACTERIA AS THE CAUSES OF DISEASE. 

Diseases may be divided into two great classes — 
the constitutional, which are due to such causes as 
errors in diet, alcoholic excesses, overwork, or age; 
and the infectious or contagious, which are due to the 
introduction into the body of a living poison. We no 
longer look upon infectious and contagious diseases 
as due to an unexplainable something, whose source 
we cannot know, whose course we cannot predict, and 
whose end cannot be hastened by any efforts on our 
part. Investigation has shown that we are no longer 
fighting an unknown enemy in the dark, but that we 
have before us a definite, living thing, whose part in 
the plan of creation is as surely fixed as our own, 
whose life-history can be told, and whose growth is 
as dependent on the right amount of light, food, heat, 
and air as that of the rose in our garden. 

The word bacteria is a general name for all the 
plant micro-organisms. Of these there are many 
different classes with different names. They vary 
much in shape and size, some being round, some 
thread-like, some rod-shaped, and some of a spiral 
form. Each single organism consists of a small speck 
of protoplasm or vegetable albumin, to which maybe 
given the name of a cell; and these cells are so minute 
that they can be seen only with the aid of the best 

21 



22 BACTERIOLOGY, 

microscopes at our command. The rounded organisms, 
or micrococci, as they are called, are seldom more than 
Y5-J0T ^f ^^ i^c^ ^^1 diameter ; the elongated cells 
average a little more perhaps, and are from xrioo 



y 




Fig. I. — Various forms of bacteria: i and 2, round and oval rnicro- 
cocci; 3, diplococci ; 4, tetracocci, or tetrads; 5, streptococci; 6, bacilli; 7, 
bacilli in chains, the lower showing spore-formation; 8, bacilli showing 
spores, forming drumsticks and Clostridia; 9 and 10, spirilla ; 11, spirochetae 
(McFarland). 

to 6^170^ of an inch in length. Different forms nat- 
urally vary from this standard of size; but these fig- 
ures will give a good idea as to the actual size of 
the forms under consideration. 

The fungi connected with disease in man are divided 
into three classes : 

1. Moulds, or hyphomycetes. 

2. Yeasts, or blastomycetes. 

3. Bacteria, or schizomycetes. 

Some bacteria, or schizomycetes, induce the various 
fermentations; while others are productive of putre- 
faction, and are called saprophytes. Others, again, 
known as the pathogenic bacteria, are the cause of 
various diseases; while those which do not ordinarily 
cause disease are known as the non-pathogenic bac- 
teria. The chief forms of bacteria are : 

1. The coccus — berry-shaped or spherical bacte- 
rium. 

2. The bacillus — rod-shaped bacterium. 

3. The spirillum — corkscrew bacterium. 



BACTERIA AS THE CAUSES OF DISEASE. 23 

And these, which are species relatively monomorphous 
— i. e. , preserve their shape — are practically the only 
ones with which we have to do. 

The cocci are named according to their arrange- 
ment with one another; if, for instance, they are in 
pairs, they are called diplococci; if in a chain, they are 

ah c </ e f 




0®@a^ #%i ii ^ 



® o 





9 



g k i j k 

Fig. 2. — Diagram illustrating the morphology of cocci : a, coccus or 
micrococcus ; b, diplococcus ; c, d, streptococci ; e, f, tetragenococci or 
merismopedia ; g, h, modes of division of cocci; /, sarcinas ; /', coccus with 
flagella ; k, staphylococci (McFarland). 

called streptococci; if in a cluster, like a bunch of 
grapes, they are called staphylococci; and if in an 
irregular mass, stuck together by a thick substance, 
they constitute a zooglea. Those developing in fours 
are called tetrads; in eights, sarcinae. 

The cocci are also named according to their func- 
tions, as, for instance, "pyogenic," or pus-forming; 
the specific name also describing the form, arrange- 
ment, color, and function; for example, Staphylo- 
cocacs pyoge7ies aureus signifies a spherical colorless 
micro-organism forming a yellow pigment, arranging 
itself with its fellows into the form of a bunch of 
grapes, and producing pus. 

As the surgical nurse carries on a daily warfare for 
the destruction of pus micro-organisms and prevention 
of their growth, she cannot be too familiar with every 



24 BA CTERIOL OGY. 

aspect of these germs. The two most constant pus 
formers are :-(i) the Staphylococcus (Fig. 2, /^), which, 
when present in a w^ound, may cause a free flow of 
pus ; still it generally manifests a milder disease con- 
dition than the virulent (2) Streptococcus germ (Fig. 
I, No. 5). 

Staphylococci may be observed under the microscope 
by placing a drop of the pus upon a cover-glass, after- 
ward spreading the specimen by applying another 
cover-glass ; dry over an alcohol lamp and stain with 
a solution of methylene-blue. Wash away the excess 
and place the specimen face down upon a glass slide. 
Streptococci are best stained by the so-called Gram's 
method. To a dried and spread drop of pus upon a 
cover-glass apply an excess quantity of the following : 

Anil in, 4 parts. 

Saturated alcoholic solution of 

basic anilin dye, 11 " 

Water, • 100 " 

Stain in this for fifteen minutes ; transfer to Gram's 
solution : 

lodin, 4 parts. 

Potassium iodid, 2 " 

Water, 300 " 

Stain for four minutes ; remove and wash the speci- 
men in 95 per cent, alcohol ; finally stain in the fol- 
lowing for half a minute : 

Bismarck brown, 3 parts. 

Water, 70 '' 

Wash in 95 per cent, alcohol ; clear the specimen by 



B-ACTERIA AS THE CAUSES OF DISEASE. 25 

adding a few drops of carbolxylol ; place upon a glass 
slide for observation. Anyone capable of developing 
an ordinary kodak film will find but little difficulty 
in learning this apparently deeply mysterious technic 
of the bacteriologic laboratory. 

Bacteria reproduce in two ways : By direct division 
(fission) and by the development of spores or seeds 
(sporulation). The most common mode is by binary 
division, one body dividing itself so as to form two 
other bodies; these two re-dividing, and so on. It 
can readily be imagined how quickly an appalling 
increase in their numbers can be thus brought about; 
but fortunately this multiplication only takes place to 
advantage under certain favorable conditions; if these 
are not present, the bacterium begins to degenerate, 
but usually does not die until it has left behind a spore. 
When the formation of a spore is about to commence, 
a small bright point appears in the protoplasm, and 
increases in size until its diameter is nearly or quite 
as great as that of the bacterium. As it nears perfec- 
tion a dark, highly refracting capsule is formed about 
it. As soon as the spore arrives at perfection the bac- 

Co^ < 2> (O) O o Cg^) @=3 

a b c d e f 

Fig. 3. — Diagram illustrating sporulation: a, bacillus inclosing a small, 

oval spore; b, drumstick-bacillus, with terminal spore; c, Clostridium, with 

central spore ; d, free spores ; e and /, bacilli escaping from spores 

(McFarland). 

terium seems to die, as if its vitality were exhausted 
in the development of the permanent form. As soon 
as the young bacillus escapes it begins to increase in 
size, develops around its soft protoplasm a character- 



26 BACTERIOLOGY. 

istic membrane, and having once established itself 
presently begins the propagation ofits species by fission. 
In those forms of organism in which spores are not 
fonnd the germs die very rapidly unless the conditions 
for their nutrition and multiplication remain very 
favorable. If all bacteria were of this kind, it would 
be possible to exterminate them with consider- 
able rapidity. Spores will survive a great heat, a 
heat which will kill the organism from which the 
spore came; they will also live under a treatment 
with germicidal solutions which renders the bacteria 
inactive. In other words, the spores are much more 
resistant to the effect of germicides than the bacteria 
themselves. Cold does not kill them; they live 
through it and develop whenever favorable surround- 
ings for their growth present themselves. They may 
lie dormant in the system for years, waking into 
activity only when they come into contact with some 
damaged, weakened, or diseased part which affords 
them a nest in which to develop and multiply, the 
cellular activity of the weakened part being unable to 
cope with the organisms. 

The conditions which influence the growth of bac- 
teria are, first, a temperature ranging from 85° to 104° 
F., some forms requiring a higher and some a lower 
temperature. Some formes of bacteria are not influ- 
enced in their growth by the presence or absence of 
light. To some, sunlight is destructive. A few 
hours' exposure to the sun is fatal to the anthrax- 
bacillus and to cultures of the Bacillus tuberculosis. 
The rays of the sun, however, must come into contact 
with the germs and are usually active only on the 
surface of cultures. 



BACTERIA AS THE CAUSES OF DISEASE. 2/ 

The majority of bacteria grow best when exposed 
to the air. Some develop better if the air is with- 
held; some will not grow at all if the least amount 
of oxygen is present. Those that grow in oxygen are 
called the aerobic bacteria, and those that will not 
grow in the presence of oxygen are the anaerobic 
bacteria. 

A certain amount of water is always necessary for 
the growth of bacteria, though the amount required 
may be very small. If dried, no form will multiply 
and very many forms will die. 

A soil consisting of highly organized compounds is 
also necessary for their growth and multiplication, and 
slight modifications in it may prove fatal to some 
forms of bacterial life, but be highly advantageous to 
others. 

With age bacteria lose their strength and die. So 
we see that a suitable soil, and a proper amount of 
light, heat, and air are absolutely necessary for the 
growth and development of bacteria, for they carry 
on all the functions of a higher organized life; they 
breathe, eat, digest, excrete, and multiply. 

The disease-producing bacteria effect entrance into 
the interior of the body through the skin and super- 
ficial mucous membranes, wounds, alimentary canal, 
respiratory tract, and placenta. 

The entrance of bacteria into the tissues through 
the sound skin is very rare indeed, although some 
authorities claim that infection has taken place 
through the rubbing of bacteria or their spores upon 
the skin. The dangers of infection through the 
broken skin are well recognized; hence every wound, 
no matter how slight, should be protected as soon as 
possible. 



28 BACTERIOLOGY. 

Bacteria enter the alimentary canal through the 
food and drink. Typhoid infection has taken place 
through the rectum, its occurrence being due to the 
wearing of underclothing previously worn by typhoid 
fever patients, and to the use of enema syringe tips 
which had not been sterilized after their previous use. 

Bacteria enter the respiratory tract through the 
mouth and nose, as in a deep inspiration, or an act 
of coughing, sneezing, or the like. Pneumonia 
and tuberculosis are said to be the result of in- 
spiration of the specific organisms. The direct 
transmission of bacteria from a parent to the fetus 
has long been a disputed question, but is now gener- 
ally conceded. The micro-organisms pass through 
the placenta and infect the fetus. Tuberculosis of 
the ovaries, Fallopian tubes, and uterus may origi- 
nate through the blood, and infection from without 
through the vagina. Infection through the blood is 
evidenced by the general tuberculosis of all the vis- 
cera. Infection from without may result in tuber- 
culosis of the uterus, ovaries, and Fallopian tubes. 

The channels by which bacteria can enter the 
body are, then very numerous; and there is scarcely 
a moment in which some part of the body is not in 
contact with them. All the disease-producing germs 
have their favorable seat in some part of the body 
where they grow more or less luxuriantly, and in the 
secretions and excretions of which the chief source 
of their infection lies. The pneumonia-germ prefers 
the lungs; the typhoid fever germ selects the lower 
portion of the small intestine; the diphtheria-germ 
the throat; the cholera-germ the intestinal tract; 
the germ of tuberculosis prefers the lungs, but it is 



BACTERIA AS THE CAUSES OF DISEASE. 29 

called a "medical tramp,'' because it will lodge in 
any part of the body and make its home there. 
Hence we hear of tuberculous glands of the neck, 
tuberculous knee, intestinal tuberculosis, tuberculosis 
of the kidney, bladder, uterus, ovaries. Fallopian 
tubes, tuberculous peritonitis, etc. A tuberculous 
area is always a danger to the system, and may infect 
distant organs or give rise to a general tuberculosis. 
To prove that a microbe is the cause of a disease it 
must fulfil Koch's circuit. It must always be found 
associated with the disease, and it must be capable 
of forming pure cultures outside the body. These 
cultures must be capable of reproducing the disease, 
and the microbe must again be found associated with 
the morbid process thus reproduced. In other words, 
we must prove the bacteria to be always present; we 
must then isolate them, then prove that they can 
produce the disease in a healthy animal, and, finally, 
having succeeded in doing all this, we must prove 
that no other form of bacteria can produce the 
disease, and that where these bacteria cannot be 
obtained the existence of the disease is impossible. 
All these requirements have been met in many 
instances, and now there are a large number of dis- 
eases each one of which has been definitely proved to 
be caused by a germ of its own, a germ which pro- 
duces that disease and no other. Most of the germs 
need a special train of circumstances in order that they 
may be active, so that, fortunately for us all, the 
mere presence of the germ itself is not sufficient to 
produce the disease. For instance, we know that 
diphtheria is caused by a germ of its own which 
causes that disease and no other; still, exposure to 



30 BACTERIOLOGY. 

that germ does not invariably produce diphtheria — if 
it did, we should all be infected with it. This is 
because other conditions than the mere presence of 
the germs are needed to produce the disease. The 
germs must be active, and they can act only under 
certain conditions. It will usually be found that the 
attack of the disease has been preceded by a local 
inflammation of the throat, thus making a suitable 
place for the specific action of the diphtheria-germs. 
In typhoid fever the germs require a suitable condi- 
tion of the bowels before they can produce the dis- 
ease. This is also true of cholera, and explains why 
taking care of the health makes such a difference in 
the taking of this disease. The germs find their way 
into the body through the food and drink. Cases are 
reported that show how the germs enter drinking- 
water, which is sprinkled over vegetables sold in the 
streets of cholera-infected districts, how they are car- 
ried about in clothing, and taken to articles of food 
upon the table by flies which have preyed upon chol- 
era excrement. Healthy lungs are not a suitable loca- 
tion for the development and activity of the germs of 
tuberculosis. If we are not fully in good health, or 
if we inherit a tendency to this special disease, we 
may acquire it very readily, since we often inhale the 
germs of it. Should the disease take root in our 
lungs, it may be controlled to a certain extent by a 
change of climate and surroundings; by going, for 
example, from a low and damp locality to the mild 
and dry atmosphere of Colorado, the Carolina moun- 
tains. Southern California, or of the other South- 
western States, where there are few cloudy days and 
where violent atmospheric changes are rare. The 



BACTERIA AS THE CAUSES OF DISEASE. 3 1 

germs there cannot be so active, for the air is stimu- 
lating, pure, and invigorating to the nervous system. 
The rarefaction of the air causes deep and strong 
involuntary respiratory movements, and there is con- 
sequently enforced a better ventilation of the lungs 
and a better oxygenation of the blood, in conse- 
quence of which there follow more active tissue- 
changes throughout the body and a strengthening 
of the respiratory muscles. 

On finding favorable conditions it takes germs some 
days to develop and produce the disease; this time is 
known as the period of incubation. 

The question is often asked. Why, when we are so 
constantly in contact with disease-germs, do we not 
contract the diseases? All bacteria leave the body 
through the skin, lungs, kidneys, or bowels; and 
by a faithful use of disinfectants and antiseptics 
the germs may be kept confined to their original 
position. After their escape from the body they are 
difficult to control. The scales of skin or dandruff 
from a case of scarlet fever, measles, or small-pox, or 
the dust that arises from the dried sputum of a 
pneumonia or tuberculosis patient, or the poisonous 
material which may enter our drinking-water from 
too close proximity of the well and the sewer into 
which typhoid discharges have been emptied, may 
readily be the means of propagating disease. These 
sources of infection should be scrupulously avoided. 
Another protective factor is the natural or acquired 
power of resistance to disease-producing germs. 

Immunity is either natural or acquired. Of 
acquired immunity we have two varieties, that which 
comes from acclimatization, and artificial immunity. 



32 BACTERIOLOGY. 

By natural immunity is meant the natural and 
constant resistance to disease-producing germs. The 
individual is immune by Nature, and sometimes by 
racial characteristics. Acquired immunity is a 
power of resistance attained through various cir- 
cumstances. Thus, a single attack of some of the in- 
fectious and contagious diseases usually confers im- 
munity against subsequent attacks. Such immunity 
generally follows an attack of typhoid fever, small- 
pox, scarlet fever, mumps, whooping-cough, measles, 
or yellow fever. Second attacks may occur ; but, as 
a rule, a patient who has had an attack of one of 
these diseases has immunity for life. Influenza, 
pneumonia, cholera, diphtheria, and erysipelas are 
among the diseases in which one attack is not 
protective. Vaccination usually insures immunity 
against small-pox; but this is ordinarily not so com- 
plete or permanent as that resulting from an attack 
of the actual disease. 

Acclimatization immunity is exemplified by vari- 
ous diseases which do not trouble natives or those 
long resident, but which may affect strangers not im- 
mured to the climate. 

Racial immunity is that in which certain races are 
safe from certain diseases; for instance, negroes sel- 
dom suffer from yellow fever, but are more suscep- 
tible than whites to small-pox. In the former case 
doubtless due to the sweat odor of this race proving 
repellant to mosquitoes, the recognized medium of 
transfer of this disease germ. It is asserted that the 
Arabs seldom or never have typhoid fever. An analo- 
gous example is afforded by the fact that white mice 
are not affected by the same diseases as the gray mice 



BACTERIA AS THE CAUSES OF DISEASE. 



33 



are, even tliougli subjected to the same influences in 
respect to climate, food, and surroundings. 

Artificial immunity may be produced in various 
ways. It is said that an injection of tlie antitoxin of 
diphtheria will give protection against the disease for 
from four to eight weeks. Tetanus has been prevented 
in a similar manner. It is impossible here to enter, 
except in a slight degree, into the consideration of 
the many theories of immunity, since they are very 
intricate, and not one has been advanced so far that 
can clearly explain it. The theory of phagocytosis 
and the theory of antitoxins are the two most im- 
portant. 

Phagocytosis is the destruction of bacteria by the 
white cells of the blood and the cells of fixed tissues. 
The cells which eat up and destroy the germs are called 
^' phagocytes." When the two meet a battle occurs, 
the bacteria fighting the cells with their active fer- 




FlG. 4. — Phagocyte destroying a bacillus (Landerer). 



ments, while the cells on their side put forth every 
effort to protect the body against the assaults of the 
disease. In a majority of the cases the bacteria win 
to the extent that the phagocytes die; but others take 
their place until the infection is overcome or the 
patient dies. The white blood-cells and tissue-cells 
having thus been educated to withstand the poison, 



34 BACTERIOLOGY, 

their descendants inherit this capacity and are born 
insusceptible. This theory was suggested by Carl 
Roser in 1881. Sternberg and Koch afterward put 
forth the same view, but it is usually credited to 
Metschnikoff, who published his observations in 
1884. 

The other theory — the so-called antitoxic theory — 
is founded on numerous more or less convincing ex- 
periments. If an animal be injected with certain 
pathogenic bacteria or their toxins in gradually 
ascending doses, it can be immunized to doses that 
under other circumstances would prove fatal. The 
blood-serum of an animal thus immunized has the 
power, when injected into another animal, of ren- 
dering it also immune to the bacteria that have 
originally been used; and in some cases the serum 
is even capable of curing the disease after it has 
developed in another animal. These properties with 
which the blood-serum has become endowed depend 
upon the presence of what are called antitoxins and 
antibacterial bodies. In man also, after recovery 
from certain infectious diseases, it is possible to 
demonstrate in the blood-serum the presence of anti- 
toxic substances; and it is now the general belief 
that immunity, at least of the acquired form, is due 
to such antitoxins. The uses and practical prep- 
aration of antitoxins will be described in the next 
chapter. 

The most important of the special surgical micro- 
organisms — i. e. , those most frequently met with in 
surgical work — are the following, the majority being 
pus-producers : 

I. Staphylococcus Pyogenes Aureus. — This is the 



BACTERIA AS THE CAUSES OF DISEASE. 35 

most common form; it is quickly killed by carbolic 
acid (i : 20), bichlorid of mercury (i : 1000), or by a few 
moments' boiling. It is found in the mouth, alimen- 
tary canal, and under the nails; it lives in the eyes, 
nose, ears, mouth, in the superficial layers of the skin, 
and is distributed in the water, soil, and air, especially 
in the dust of houses and surgical wards where the 
proper precautions are not taken. 

2. Streptococcus pyogenes is a most important path- 
ogenic micro-organism, and is thought by many 
authorities to be identical with the streptococcus of 
erysipelas. The Streptococcus pyogenes is frequently 
associated with internal diseases, and has been found 
in the uterus in cases of infective puerperal endome- 
tritis, ulcerative endocarditis, acute septicemia, and 
other diseases. It is one of the most common causes 
of post-operative peritonitis. 

3. The Bacillus coli communis is always present in 
the intestine, and, while ordinarily active in the proc- 
esses of digestion, it is thought to be a frequent 
cause of acute suppurative peritonitis. 

4. The Staphylococcus pyogenes albus resembles the 
aureus in form, but is less virulent. It is a common 
cause of suppuration, and although it has been found 
alone in acute abscesses, it is usually associated with 
other pyogenic cocci, chiefly the Staphylococcus pyo- 
genes aureus. 

5 . The Staphylococcus epidermitidis albus is a micro- 
coccus which is almost always present upon the skin, 
not only upon the surface, but also in the outer layers. 

6. The Staphylococcus pyogenes citreus is n'ot quite 
so common nor so pathogenic as the other forms, and 
is less important. 



36 BA CTERIOL OGY. 

7. The Bacillus pyocyaneus exists in pus (especially 
in open wounds), and gives to it a peculiar bluish or 
greenish color. 

8. The Bacillus aerogenes capsulatus is a gas-pro- 
ducing bacillus that sometimes causes death after 
operations on the uterus; it may also enter through 
accidental wounds. 

9. The Bacillus tuberculosis is the cause of all tuber- 
culous processes. The chief cause of the spread of 
infection is found in the dried sputum, which becomes 
pulverized and is then inhaled as dust ; and since 
one patient may expectorate as many as four billion 
bacilli in twenty-four hours, his capacity for harm is 
very considerable. The bacilli retain virulence for five 
months in dried sputum, and in putrid sputum for 
forty-three days. 

10. The Micrococcus lanceolatus^ known also as 
Streptococcus lanceolatus, pneumococcus, and Diplo- 
coccus pneumoniae, is the cause of croupous pneu- 
monia and of many of the acute inflammations of the 
serous membranes of the body. It is also a pus-pro- 
ducer, and has been found in empyema and acute 
abscesses. 

11. The bacillus of tetaitus is found particularly in 
garden-soil, in the dust of halls, walks, cellars, street- 
dirt, and in the refuse of stables. It is not a pus- 
producer. Tetanus is a disease due to the absorption 
of its toxins, which poison the nervous system pre- 
cisely as would dosing with strychnin. 

12. The diphtheria-bacillus causes the dreaded dis- 
eases diphtheria and membranous croup, as well as 
inflammations of the eyes and nose; at times it also 
attacks open wounds. 



CHAPTER III. 
THE THEORY OF ANTITOXINS. 

Great progress has been made of late in the field 
of serum-therapy, though much remains open to ques- 
tion and many recorded facts cannot yet be explained. 
The field for the investigator is perhaps larger than 
ever before. For a better understanding of the sub- 
ject of antitoxins and their therapeutic application, a 
few essential facts should be borne in mind. An anti- 
toxin is not the direct result of bacterial action, but 
is properly described as an unknown body resulting 
from the resistance of the healthy organism' to the 
toxins of pathogenic bacteria. According to the pre- 
vailing theory, antitoxins are the products of the 
body-cells, formed under the influence of the bacterial 
.toxin. In therapeutic practice the antitoxic body 
comes to us in the blood-serum of an animal, usually 
the horse. When properly prepared and properly 
kept in aseptic containers the antitoxins are not at all 
dangerous; they are as innocuous as an equal amount 
of blood-serum or normal salt solution administered in 
the same way. Antitoxins are used both to counteract 
the effects of the toxins which are elaborated by path- 
ogenic bacteria in the body, and to render the sys- 
tem immune, so that it may resist the action of the 
bacteria should they gain access to the body. The 
antitoxins do not destroy the bacteria; in other words, 



38 BA CTERIOL OGY. 

they are not germicides. In fact, the antitoxic serums 
are themselves good culture-media. One theory of 
their action is that they neutralize the toxin, thus 
giving the natural bactericidal powers of the body an 
opportunity to exercise their function. 

The following is a brief description of the process 
employed in the laboratory of Parke, Davis & Co., 
for the preparation of diphtheria-antitoxin : 

Young horses in perfect condition are selected and 
kept under careful observation by an expert veterina- 
rian for three or four weeks. During this time they 
are carefully tested with tuberculin for the possible 
existence of unsuspected and undeveloped tubercu- 
losis, and with mallein for glanders. When a horse 
is found to be perfectly healthy it receives its first 
dose of diphtheria-poison, or more properly a solution 
of the toxin of the diphtheria-bacillus. This is pre- 
pared in the following manner : A culture is obtained 
from the throat of a patient suffering from a virulent at- 
tack of diphtheria. The diphtheria-bacill us is isolated 
from this culture and planted in a flask of bouillon 
or beef-tea, which is then kept in an incubator from 
three to four weeks. At the end of this time it has 
attained its maximum toxicity and the bacteria begin 
to die of their own poison. The toxin which they 
have elaborated in the course of their existence is held 
in solution in the beef-tea. This bouillon solution 
of toxin is then filtered through porcelain to remove 
the bacterial cells and any other extraneous matter. 
It is then ready for injection into the horse. About 
one-tenth of one cubic centimeter is injected intra- 
venously. The horse responds with all the constitu- 
tional symptoms of diphtheria, such as a chill, fever, 



THE THEORY OF ANTITOXINS. 39 

loss of appetite, more or less pharyngeal paralysis, 
witli regurgitation of food. Sometimes death occurs 
from heart-paralysis. Upon recovery, which comes 
within a few days, a slightly larger dose is given. 
This treatment is continued for about one year, at the 
end of which time the horse will take from 2000 to 
3000 times the initial dose without reaction. It is 
then ready for bleeding. About 6000 cubic centi- 
meters of blood are drawn from the external jugular 
vein. This is allowed to clot, and the serum obtained 
is known commercially as antitoxin. It is customary 
to add an antiseptic, such as trikresol, to preserve the 
serum. 

In preparing the streptococcus antitoxin a culture 
is made of bacteria obtained from two sources — ery- 
sipelas and puerperal septicemia. This is done be- 
cause some eminent bacteriologists believe that the 
streptococcus of erysipelas is not identical with the 
streptococcus of puerperal fever. It is but fair to say, 
however, that others equally eminent assert the iden- 
tity of the two streptococci. To meet the possibility 
of the non-identity of the organisms, a culture ob- 
tained from the two sources is used. Its virulence is 
increased by passing it through rabbits. After pass- 
ing through about fifty rabbits a culture is planted in 
beef-tea, and the same course pursued as for diphthe- 
ria-antitoxin. Antitubercle serum is obtained by im- 
munizing horses with the original Koch's tuberculin. 

As to the therapeutic action of antitoxin, little or 
nothing is known positively. It seems reasonable to 
conclude from experimental evidence that the anti- 
toxin neutralizes the toxin in the body and thereby 
gives the natural germicidal powers an opportunity 



40 BACTERIOLOGY. 

to dispose of the bacteria. It may be that it has the 
additional property of stimulating the phagocytic and 
possibly other bactericidal functions. The following 
experiments made by Martin and Cherry, of Mel- 
bourne, Australia, and described in the Jour, of the 
Amer. Med. Assoc, of August 27, 1898, are of interest in 
this connection. Behring, Ehrlich, and Kanthack have 
advocated the theory that the antagonism between 
toxins and antitoxins is achemicone, somewhat anal- 
ogous to the neutralization of an acid by an alkali; 
while Buchner, Metschnikoff, and others have main- 
tained that it is indirect and operates through the 
cells of the organism. Martin and Cherry used a 
snake-venom antitoxin. A large number of guinea- 
pigs were used. At 6o°C. the antitoxin was destroyed, 
while the venom retained its virulence. In the con- 
trol-experiment with the venom only, all the animals 
died within a few hours. A number of mixtures were 
made of i c.c. of antitoxin with twice the fatal dose 
of venom ; others with three or four times the fatal 
dose. These mixtures were allowed to stand at the 
usual laboratory temperature (20° to 23° C.) for two, 
five, ten, fifteen, and thirty minutes respectively, then 
heated to 68° C, and afterward injected. 

As remarked above, this heat destroyed the anti- 
toxin, so that none was injected. The animals sub- 
jected to the mixture of the stronger doses of ten min- 
utes or less died or were seriously affected; all of those 
receiving the fifteen-minute mixture survived; while 
the thirty-minute mixtures produced no symptoms 
whatever. Similar results were obtained with diph- 
theria-antitoxin and toxin. These experiments seem 
to show, as far as anything can, that the neutraliza- 



THE THEORY OF ANTITOXINS. 4 1 

tion of toxins may occur in the test-tube, and that the 
vital processes in the organism and the body-cells are 
not essential. These gentlemen made further exper- 
iments by passing a mixture of toxins and antitoxins 
through a Pasteur-Chamberland filter. This was po- 
rous for toxin, but not for antitoxin, owing to the 
difference in the size of their molecules. The toxin 
which passed through the filter, after having been 
mixed with antitoxin, w^as neutral. The unavoidable 
conclusion from this experiment is that the toxin was 
neutralized before filtration. 

Experiments have been tried in order to prove the 
theory that toxins are albumoses and antitoxins globu- 
lins; but these experiments do not appear to be con- 
clusive as to this point. 

The supposition that the administration of antitoxin 
is followed by a stimulation of the germicidal powers 
of the body seems to be reasonable, at least in the 
case of the antistreptococcic serum, since the strepto- 
cocci disappear with the passing away of the signs 
and symptoms. On the other hand, the Klebs-Ivoeflf- 
ler bacillus is found in the throat for weeks and even 
months after the disappearance of all symptoms of 
diphtheria in cases treated with the antitoxin. 

The present status of diphtheria-antitoxin may be 
presented in a few words. It has established itself as 
a specific in the treatment of this disease. During 
the past year the use of larger doses has become more 
general, and it seems certain that better results were 
obtained. The administrators of the Chicago Depart- 
ment of Health give 2000 units in all cases of sus- 
pected diphtheria, and employ 1000 units as an im- 
dose. Durino^ the months of November 



42 BACTERIOLOGY. 

and December, 1898, this department treated 219 
cases of bacteriologically proved diphtheria — all char- 
ity cases — with a death-rate of 4. i per cent. Some 
two and a half years ago, when antitoxin was not used, 
the death-rate from diphtheria treated by this depart- 
ment was about 35 per cent. 

Antistreptococcic serum gives promise of being 
second only to the diphtheria-antitoxin in point of 
therapeutic value. It has been most successful in 
erysipelas and puerperal septicemia. Cases of scarlet 
fever are reported in which it has been useful in 
shortening the duration of the disease and in pre- 
venting unfortunate complications and sequelae, such 
as otitis media and other suppurative processes due to 
streptococci. 

A mixture of the toxin of the streptococcus of 
erysipelas and the products of a harmless germ, the 
Bacillus prodigiosus, is used by Coley and others as an 
injection in malignant tumors that are past the stage 
of operation or are so situated that an operation is im- 
possible. 

It is to be regretted that tetanus-antitoxin does not 
in clinical use do all that it will do in the laboratory. 
It has been used in a considerable number of cases, 
but in nearly every instance without any result that 
would justify us regarding it as a great curative 
agent. Nevertheless, it should be used early in 
every case of tetanus, the patient thereby having a 
somewhat better chance of recovery. 

One or two cases have been successfully treated 
with intracerebral injections of antitoxin, the theory 
being that the antitoxin should be placed where it 
could neutralize the toxin which is producing the 



THE THEORY OF ANTITOXINS. 43 

convulsions by means of its action on the nerve- 
centers. The value of this method of administration 
has not been proved. 

As a preventive measure the use of tetanus-anti- 
toxin is strongly commended. 

An antityphoid fever serum has lately been devel- 
oped which, if proved successful, must become of 
the greatest value in the prevention and cure of this 
insidious disease. 

The antitubercle serum has not shown itself to 
have more value than a great number of other 
remedies vaunted as specifics in tuberculosis. 

Method of Injecting Antitoxin. — The serums and 
toxins are given hypodermically, the injection being 
made into the back, thigh, side of the breast, or over 
the chest. Perfect antisepsis for the operation is 
absolutely necessary. The puncture-wound is closed 
with a collodion dressing. It is not necessary to use 
massage for the purpose of causing more rapid ab- 
sorption of the injected serum — the swelling gener- 
ally disappears in a short time of itself. Sometimes 
the site of the injection becomes very painful. In 
certain cases, pains in the joints and various skin- 
eruptions (erythema, hives) develop after the injec- 
tion. They are not of great moment, but the physi- 
cian's attention should be called to them. 

The reaction following an injection of Coley's 
mixture is sometimes severe, and may correspond 
to the symptoms beginning an attack of erysipelas — 
chill, local redness, and high temperature. 



CHAPTER IV. 

ANTISEPTICS, DISINFECTANTS, AND 
DEODORANTS. 

Substances which retard or check the growth of 
bacteria amid otherwise suitable surroundings are 
called antiseptics. 

Articles and wounds which are entirely free from 
bacteria and their spores are termed aseptic or sterile. 

Disinfectants or germicides entirely destroy the 
vitality of bacteria. Excessive heat, dry or moist, is 
a true disinfectant, because it entirely destroys bac- 
teria, while cold is an antiseptic; it does not kill bac- 
teria, but retards their development. 

A chemic agent which will cause the death of bac- 
teria is called a ger^nicide. 

A deodorant is an agent that destroys bad odors. 
A disinfectant is an antiseptic, and may be a deodo- 
rant; but because a substance has the power to de- 
stroy bad odors it does not follow that it has the power 
to destroy the bacteria which are the cause of the 
odor. Carbolic acid, for instance, is a disinfectant 
and deodorant; while Piatt's chlorides is a prompt 
deodorant, but has almost no disinfectant power. 

The power of a chemic agent to destroy bacteria 
depends on several conditions : 

First. The kind of bacteria, some being easily killed 

44 



ANTISEPTICS, DISINFECTANTS, AND DEODORANTS. 45 

by an agent which is entirely harmless to others. 
Spores are much more resistant than the bacteria from 
which they are derived. 

Second. The number of bacteria present. 

Third. The temperature at which the exposure to 
the disinfecting agent is made; the higher the tem- 
perature the greater the effect. 

Fourth. The strength of the solution; a small quan- 
tity of a strong solution of corrosive sublimate is 
much more efficient than a large amount of a weak 
solution. 

Fifth. The nature and quality of the associated 
material. If the bacteria are associated with a large 
amount of organic matter, the chemical agent used 
may combine with the latter and may thus be con- 
verted into an ineffective material before it has an op- 
portunity to act upon the bacteria. This result must 
be especially guarded against in the disinfection of 
sputum and fecal matter. 

The agents capable of destroying bacteria are num- 
berless ; but there are many which cannot be employed 
in practice because they are too weak or act too slowly, 
or are too poisonous, or too expensive for general use 
in the required quantity, or are too destructive to the 
objects with which they come in contact. Water at 
a high temperature cannot be used for the disinfec- 
tion of the hands of the surgeon or of the field of oper- 
ation, or of organic substances in general. Corrosive 
sublimate cannot be employed in the sterilization of 
instruments, since it corrodes and blackens them; it 
also discolors clothing and furniture when used in 
strong solutions. Potassium permanganate stains 
everything with which it comes in contact. 



46 ANTISEPTICS. 

By long-continiied action in concentrated solution 
some of the agents which arrest the growth will finally 
lead to the death of those bacteria which have been 
subjected to them. Many agents, however, which 
arrest the growth of bacteria, are not capable of de- 
stroying them, and particularly their spores. Cold, 
for example, will arrest the development of bacteria 
but has no power to destroy anthrax-spores even when 
applied with the most extreme intensity. The resist- 
ance of spores is one of the strangest phenomena in 
nature; some can be boiled and some can be subjected 
to the intensely cold action of liquid air without per- 
ishing. The chief disease-producing bacteria which 
form spores and those which do not are : 

Non-spore-forming : 

1. Streptococcus pyogenes. 

2. Staphylococcus pyogenes aureus, albus, and 
citreus. 

3. Streptococcus of erysipelas (believed to be iden- 
tical with the Streptococcus pyogenes). 

4. Diphtheria-bacillus. 

5. It is doubtful whether the tubercle-bacillus is 
spore-forming. The weight of opinion favors the 
absence of spores in this organism. 

Among the spore-forming pathogenic organisms 
are : 

1. Bacillus of malignant edema. 

2. The tetanus-bacillus. 

3. The anthrax-bacillus. 

The germicidal or disinfecting agents at our com- 
mand are of two kinds chiefly, heat and chemic 
agents. The term ' ' disinfection ' ' is employed for 



ANTISEPTICS, DISINFECTANTS, AND DEODORANTS. 47 

the action of chemic agents, and ** sterilization ' ' for 
the action of heat. 

Among all germicidal or disinfecting agents heat is 
entitled to the first place, and fire, for its thorough- 
ness, is superior to all others. All infected articles 
of little value, books, playthings, etc., that can be 
burned should be thus destroyed, as should also spu- 
tum and bowel-movements. The very best way to 
treat the latter is to mix them with sawdust and then 
to burn them. 

In surgical work, for the perfect sterilization of 
articles capable of withstanding it, fire is preferable 
because of its certain action. Edged instruments and 
forceps may be exposed for a very short time to the 
direct flame; but if continued too long the temper of 
the steel is affected. 

We must remember that after sterilization there is 
always the danger of contamination, and the articles 
must, therefore, be carefully protected immediately 
after sterilization. If they are left uncovered for dust 
to collect upon them, the object of sterilization is 
defeated. 

I^ight, especially sunlight, acts as a germ destroyer. 

Heat may be applied in the form of hot air, moist 
air (steam), or boiling water. 

Boiling water kills germs on contact, and de- 
stroys anthrax-spores, as a rule, in from two to four 
minutes. 

Moist heat (steam) is the next most powerful agent. 
It is more thorough and more penetrating than hot air. 
Steam exerts its full influence only when the air is 
saturated with it. Saturated steam may be simple 
steam (quiescent), live steam (circulating steam), 



48 ANTISEPTICS. 

high-tension steam (confined under a certain pressure), 
or superheated steam (that which has been heated 
secondarily to a temperature above ioo° C). 

Live steam destroys anthrax spores in from five to 
fifteen minutes, according to their degree of resistance. 

Disinfectio7i by stemn is applicable to clothing, 
linen, blankets, towels, surgical dressings, instru- 
ments, curtains, carpets, brushes, mattresses, pillows 
(the two latter should be ripped open), and a number 
of delicate fabrics. It is not applicable to linen soiled 
by feces, blood, or pus, since the stains would become 
fixed by the process (soak first in plain cold water), 
nor to rubber articles. Under certain conditions many 
articles are exposed to the action of steam for one hour 
on three successive days,- being kept during the inter- 
vals at a temperture of 70° to 80° C. to favor the 
development of bacteria. This is called "intermit- 
tent" or "fractional" sterilization, the object of 
which is to kill all bacteria that may have developed 
from spores that escaped the first steaming. The last 
sterilization is for the purpose of making sure. 

Hot air is inferior to both steam and hot water. 
Steam at a temperature of 100° C. is more effectual 
than hot air at a much higher temperature. Accord- 
ing to investigations, exposure to a temperature of 
150° C. (302° F.) for one and a half hours in a hot- 
air sterilizer will kill all known bacteria and their 
spores. 

Osone., formed by electric discharges in water, 
may be used to improve its quality for drinking pur- 
poses. 

The list of chemic substances used as germicides 
is constantly changing, and those which are now 



ANTISEPTICS, DISINFECTANTS, AND DEODORANTS. 49 

considered the most valuable may in a little while be 
considered not so effectual as newer ones. Among 
the recognized antiseptics and disinfectants now in 
use are : 

Chlorin.^ in the free gaseous form or in watery solu- 
tion, is used for general disinfecting. 

Sulphur dioxid^ best used in the presence of moist- 
ure, is produced by burning roll sulphur (flowers of 
sulphur) in a closed receptacle. 

Corrosive sublimate^ or bichlorid of mercury, has, 
like carbolic acid, the advantage of being both effica- 
cious and cheap. It has the disadvantages that it 
is decomposed by alkalies, that it is precipitated by 
albumin, and that it corrodes metals. It is used in 
strengths of from 1:10,000 to 1:500. The solution 
should be made as it is needed, because in old solu- 
tions most of the soluble corrosive sublimate has 
been converted into insoluble calomel, and the solu- 
tion is not germicidal. By using the compressed 
tablets now on the market fresh solutions are readily 
made. A tablet usually contains the requisite amount 
of corrosive sublimate to make when added to one 
pint of water a i: loco solution, and by increasing or 
diminishing: the amount of water the streng-th of the 
solution may be altered at pleasure. The tablets 
are very convenient, and almost compel accuracy 
in the preparation. Corrosive sublimate is of less 
value for the disinfection of the excreta ' than car- 
bolic acid, as it hardens the albuminous material 
which covers the outside of all fecal masses, and 
thus protects the inside from the desired action. 
Tartaric acid, chlorid of sodium, or chlorid of ammo- 
nium is often added to prevent this. Compressed 



50 ANTISEPTICS, 

tablets, each containing tartaric acid or ammonium 
chlorid and 7J^ grains of corrosive sublimate, or 
equal, parts of chlorid of sodium and corrosive sub- 
limate, are in common use. The convenient form in 
which this drug is put up and the readiness with 
which it can be used in surgical and medical work 
have made its adoption universal. Its poisonous 
character must be kept constantly in mind. The 
first symptoms of poisoning in consequence of the 
absorption of the bichlorid are profuse salivation, 
fetid breath, a metallic taste in the mouth, sore 
teeth, spongy gums, and swollen tongue. Should 
any of these symptoms appear they should at once 
be reported to the surgeon. As the solution has no 
odor, it is occasionally swallowed in mistake. Should 
this occur, symptoms of a violent gastro-enteritis 
appear — vomiting, burning pain, bloody stools ; the 
kidneys are also affected, and an acute Bright' s dis- 
ease develops. The immediate treatment of this 
acute poisoning consists in the giving of white of 
^%%^ flour, or milk and lime-water, and washing out 
of the stomach. 

Carbolic acid^ derived from coal-tar by distillation. 
When pure, it is a solid, white, or faintly rose- 
colored, crystalline body, readily soluble in water, 
alcohol, or glycerin. On exposure to air it absorbs 5 
per cent, of moisture. A solution frequently employed 
is one of 5 per cent, strength. To make a 5 per cent, 
solution, I part of carbolic acid is added to 20 parts 
of very hot water and the whole shaken thoroughly. 
Any excess of carbolic acid above that strength 
falls to the bottom of the vessel as pinkish globules. 
Before using the solution care must be taken that the 



ANTISEPTICS, DISINFECTANTS, AND DEODORANTS. 5 I 

globules have been dissolved, or they will burn any 
living tissue with which they come in contact. Car- 
bolic acid is considered now to be the most reliable 
and useful of all the germicides and antiseptics. It 
has the advantage over corrosive sublimate in that it 
does not discolor instruments nor clothing ; but, on 
the other hand, it irritates and benumbs the skin. 
Pure carbolic acid is a reliable disinfectant for instru- 
ments. If an instrument that is indispensable hap- 
pens to fall to the floor during an operation, it may be 
laid for a moment in pure carbolic acid, then rinsed 
with sterile water, and it is ready for use. Ivong- 
continued submersion in the acid will, however, de- 
prive knives and scissors of their temper and edge. 
Symptoms of poisoning have been produced by the 
absorption of the drug from surgical dressings and 
from the use of carbolic solutions for irrigation. The 
first evidences of poisoning are a very dark greenish 
or a blackish coloration of the urine, headache, giddi- 
ness, ringing or singing in the ears, and lassitude. 
The odor of carbolic acid is, to a certain extent, a pro- 
tective against accident ; yet fatalities occasionally 
occur. The antidotes of carbolic acid are alcohol, milk, 
and lime-water, or flour and water. The strength of 
the solutions used varies from i : 80 to i : 20. The 
acid is bought usually in the liquid form, having a 
strength of 95 per cent. To make a solution i : 20 (5 
per cent.), i : 40 (2 J per cent.), i : 50 (2 per cent), i : 80 
{\\ per cent.), i ounce of the 95 per cent, solution is 
added to 20, 40, 50, or 80 ounces of water. When 
obtained in the solid form, it may readily be liquefied 
by placing the bottle in a vessel of hot water. 

Crude carbolic acid mixed with strong sulphuric 



52 



ANTISEPTICS. 



acid makes a powerful disinfectant where possible to 
employ it. 

There are other products of coal-tar distillation akin 
to, but not so poisonous as, carbolic acid. Among 
them are the following : 

Creolin. — This is a non-irritant and practically 
non-toxic germicide. Though toxic symptoms have 
been reported, it certainly is the least poisonous of 
the powerful germicides now in use. Its chief disad- 
vantage is that when mixed with water it forms an 
opaque emulsion ; consequently it is inapplicable for 
the sterilization of instruments, since they could not 
readily be found in it. For cleansing the hands and 
for irrigation, creolin is used in strengths of from 
2 to 5 per cent. The antiseptic value of creolin would 
seem to be discounted, as this reviser recalls several 
deaths from tetanus in puerperal women where tap- 
water — later proved to contain tetanus germs — was 
employed in making up creolin solutions for irriga- 
tions. To make a 2 per cent, solution, 2\ teaspoon- 
fuls of creolin are added to i pint of water. 

Lysol is a brown, oily-looking, clear liquid, with a 
creosote-like odor, obtained from tar-oils. When 
added to ordinary hard water it forms a clear, soapy 
liquid, as it precipitates the lime-salts in the water, 
but is clear if distilled water, alcohol, or glycerin 
be mixed with it Its antiseptic properties under 
no circumstances are impaired. On account of its 
saponaceous character it cannot be used for instru- 
ments, because it renders them slippery. It is much 
employed in surgery and gynecology, in solutions of 
from I to 5 per cent. To make a i per cent, solution, 
5 drams are added to ^ gallon of water. Its chief 



ANTISEPTICS, DISINFECTANTS, AND DEODORANTS. 53 

advantage over other antiseptics lies in its non-irri- 
tant and much less' poisonous properties. It can be 
used for the disinfection of everything in the sick- 
room. 

Sozal is an antiseptic obtained in small crystals 
which have an odor of coal-tar. It is said to possess 
the same advantages as corrosive sublimate without 
its toxic properties. The crystals are readily soluble 
in water, glycerin, or spirit. 

Saprol is a dark-brown oily fluid with an odor of 
carbolic acid. When mixed with water it divides 
into oil drops, some of which fall to the bottom of 
the vessel, while others float on the top of the water, 
consequently it cannot be used for surgical purposes. 
It is a powerful disinfectant, especially valuable in 
disinfecting excreta, and possesses the property of 
diffusing evenly through the material to which it is 
added. 

Other disinfectants outside of the coal-tar products 
are : 

Iodoform has been largely used as a surgical dressing. 
It has no decided antiseptic properties. It does good 
by absorbing the liquids of the wound, thereby re- 
moving one of the factors for germ growth. When 
applied to large moist surfaces it gives off free iodin. 
It prevents decomposition and inhibits, but does not 
destroy, the germs of putrefaction and pus formation 
if they are present before its use. When applied to 
raw surfaces it is occasionally absorbed into the sys- 
tem, and causes symptoms of poisoning. On account 
of this danger salol is often substituted for it, as 
is also a mixture of iodoform, i part to 7 parts of 
boric acid, it being both antiseptic and unirritating. 



54 ANTISEPTICS. 

The symptoms of absorption are headache, loss of 
appetite, rise of temperature, a rapid, feeble pulse, 
restlessness, and insomnia. These symptoms may 
pass away if the dressing is removed and discontinued. 
In grave cases there is marked anxiety, a bright- 
red eruption appears on the face and limbs, and 
there is retention of urine, with stupor, delirium, 
collapse, and death. Some patients are very sus- 
ceptible to the toxic effects of the drug. It has a 
penetrating odor, which many persons find disagree- 
able. Spirit of turpentine will at once remove the 
objectionable odor from the hands, instruments, and 
vessels that have been in contact with the drug. Iodo- 
form darkens upon exposure to a bright light and is 
likely to cake when it becomes moist. It is used for 
impregnating gauze-dressings, for dusting on ulcers 
and wounds, and for injections, dissolved in ether or 
olive oil, into sinuses or tuberculous abscesses. It is 
also used in the form of ointment. 

lodol is a pale yellow crystalline powder, almost 
insoluble in water, but readily soluble in ether and 
alcohol, less so in glycerin or oils. It is often used 
as a substitute for iodoform, having the same proper- 
ties. Like iodoform, it darkens if exposed to a bright 
light. It is used in the form of powder, solution, and 
ointment, and has the advantage of not being so poi- 
sonous as iodoform. 

Formaldehyd is a gas formed by the partial oxida- 
tion of wood alcohol; it may be produced by burning 
wood spirit in an ordinary alcohol lamp. Its use is 
greatly facilitated by having it combined with water 
in a definite proportion, so that the quantity used may 
be certain and positively known. Its solution in 



ANTISEPTICS, DISINFECTANTS, AND DEODORANTS. 55 

water is called formol, formal, and formalin, and con- 
tains about 40 per cent, of formaldehyd gas. Formal- 
dehyd is non-poisonous, colorless, with a pungent, 
irritating odor, and possessing great antiseptic, disin- 
fectant, and deodorant powers. Its activity as a ger- 
micide is considered to be equal, if not superior, to 
that of bichlorid of mercury, and it is available in 
many cases in which the latter cannot be used. It 
does not corrode or tarnish metals, nor injure the finest 
fabrics either in texture or color. As a deodorant it 
removes immediately the odor of feces, urine, septic, 
or gangrenous material. It may be used externally in 
the form of solution, spray or vapor, and is sometimes 
added to powders. In solution as a wash or irrigation 
in wounds, it is employed in strengths varying from 
0.5 to 20 per cent. As a dusting-powder it is used in 
combination with gelatin. Sheets of moist gelatin, 
after exposure to formalin fumes, are ground to a 
coarse powder, used in the dressing of wounds. A 
slight disadvantage is that for four or five hours after 
its use on a raw surface it produces more or less pain 
of a burning nature. In the form of vapor it is used 
for sterilizing instruments and surgical dressings, and 
for the fumigation of the sick-room and its contents. 
The simplified method of fumigating consists of di- 
luting one pound of formalin with three times its vol- 
ume of hot water, and boiling over a flame for half an 
hour. The generated gas is very penetrating, and 
having the same specific gravity as the air, soon per- 
meates the room in which it is confined, and kills all 
germs, not protected by moisture, in about three 
hours. Special portable forms of apparatus have been 
devised for purposes of room-disinfection. Spray dis- 



56 



ANTISEPTICS. 



infection of rooms with a 2 per cent, formalin solution 
is also very satisfactory. 

For the sterilization of instruments a i : 2000 solu- 
tion is used. 




Fig. 5. — Formaldehyd generator. ' 

Formaldehyd vapor when inhaled irritates the lungs. 
It also irritates the eyes and nostrils, causing them to 
smart. 

A fatal case of formalin-poisoning is reported, the 



ANTISEPTICS, DISINFECTANTS, AND DEODORANTS. 5/ 

amount taken being about 3 ounces of a 4 per cent, 
solution. Immediately after taking there was pain in 
the stomach and vomiting. The vomited matter was 
blood-stained and had the pungent odor of formalin. 
The patient died of heart-failure thirty-two hours 
afterward. The treatment consisted in albumin-water, 
free emesis, heart-stimulants, and normal saline solu- 
tions given both hypodermically and intravenously. 

Aristol (thymol iodid) is a reddish-brown powder 
containing about 45 per cent. ®f iodin. It is used as 
a substitute for iodoform. It has not the disagreeable 
odor of iodoform, and its use is attended with less 
danger of poisoning. It is used in the form of fine 
powder or ointment, the strength of the latter varying 
from J to I dram to the ounce of pure lard. 



CHAPTER V. 

ANTISEPTICS (Continued). 

Hydrogen dioxid or peroxid of hydroge^t is a popular 
antiseptic. It is an excellent agent for the destruction 
of pus-cocci. When poured or injected into a wound, 
effervescence takes place, the result of chemic reac- 
tion between the wound-secretions and the h3^dro- 
gen peroxid, causing coagulation of albumin and the 
setting free of gas. This active frothing serves to 
carry off any shreds of tissue in the wound that cannot 
easily be reached. It may likewise do harm by bur- 
rowing the cellular tissues. The peroxid is also 
applied to the throat in diphtheria to destroy and 
remove the false membrane. It readily decomposes 
by coming in contact with metals ; consequently, if 
used as a spray, a glass atomizer must be employed. 
The hydrogen peroxid in common use is a clear, odor- 
less fluid, having a bitter taste. The official solu- 
tion contains 3 per cent, of the pure dioxid, which 
corresponds to about ten volumes of available oxygen, 
and it is upon its readiness to yield oxygen that its 
activity depends. The solution should be kept in a 
cool, dark place, and the cork forced tightly into the 
bottle ; when removing the stopper always point the 
bottle away from the face. 

Boracic acid (boric acid) is a mild antiseptic. It is 
non-irritating and practically non-poisonous. It is 
therefore frequently used to wash out cavities, for in- 

58 



ANTISEPTICS. 59 

jections, and in ophthalmic and aural practice. It is 
used in the form of powder, solution, ointment, and 
gauze. In solution, a saturated solution is used (a sat- 
urated solution is one in which the water dissolves as 
much as it will of the drug; the remainder lying at the 
bottom of the vessel as an indication that the solution 
is sufficiently strong). It is easily made by placing 
one-half pound of boric acid in a half-gallon bottle 
filled with boiled water and shaking thoroughly until 
saturated. It is impossible to use a solution which 
is too strong, because the water cannot take up any 
more than i in 30 (about 4 per cent.), which is the 
usual strength used. In rare cases it acts as an irri- 
tant to the skin and produces an eczematous condi- 
tion. 

Boroglycerid is a non-poisonous antiseptic solution 
made from boric acid and glycerin, and is used as a 
wash, an irrigation, and for saturating tampons. 

Thiersch'' s solution is an antiseptic of moderate 
power, unirritating and non-poisonous; it contains 
salicylic acid, 2 parts; boric acid, 12 parts; hot 
water, 1000 parts. 

Alcohol. — Absolute alcohol is an antiseptic and dis- 
infectant used for cleansing the skin, for the prepara- 
tion of sutures and ligatures, and for the disinfec- 
tion of cutting-instruments. To sterilize the hands, 
they are scrubbed for five minutes with soap and hot 
water, then scrubbed for the same length of time in 
absolute alcohol, and finally rinsed in an antiseptic 
solution. The results obtained by the disinfection 
and cleansing of the skin with alcohol have been as- 
cribed to the solvent action of the alcohol upon the 
fatty matters on the skin, thus allowing corrosive 



60 ANTISEPTICS. 

sublimate and other antiseptics to come into imme- 
diate contact with the bacteria. Scrubbing the 
hands in absolute alcohol for five minutes takes up 
both the fatty matters of the skin and also the bac- 
teria, which are thus washed away. 

Potassium permanganate^ or permanganate of 
potassium, is an antiseptic, disinfectant, and deodor- 
ant, depending for its action on its oxidizing prop- 
erties. It parts with its oxygen very readily, to 
organic substances and becomes inert. Its chief dis- 
advantage is that it stains everything a brownish- 
black color. It is used in solutions varying from 
i:iooto i:io. When employed for sterilizing the 
hands, it is followed by oxalic acid solution, which 
has the property of removing the stain. It is also 
used on wounds, especially those which have an 
offensive discharge, as, for example, gangenous 
ulcers, on which it acts as a deodorant as well as a 
disinfectant. It may also be employed to disinfect 
bowel-movements, to flush water-closets, etc. Its 
advantages are that it is non-poisonous in ordinary 
strengths, rapid and complete in its action, and 
shows by its change of color from reddish-purple to 
a brown whether it is acting or whether it is ex- 
hausted. The strength of the solution generally used 
is from 20 to 16 grains of the crystal to i pint of 
water. 

Oxalic acid is a powerful germicide, though it is 
not used alone, but to remove the stains of potassium 
permanganate from the skin. It is very poisonous 
and quite irritating, but the irritation can in a meas- 
ure be avoided by immersing the hands and forearms 
afterward in either plain water or lime-water. A 



ANTISEPTICS. 6 1 

series of experiments by Dr. Howard A. Kelly, to 
determine the relative part played by these two 
chemicals in the process of disinfection, led to the 
conclusion that both the permanganate of potassium 
and oxalic acid were germicides, but that the oxalic 
acid at a temperature of about 40° C. (104° F.) is a 
much more powerful germicide than the permangan- 
ate of potassium. Oxalic acid also removes perman- 
ganate stains from white goods, and ammonia will 
remove the stains from black goods. 

Potassium permanganate is frequently used in a 
solution called Condy^ s fluid^ which consists of a 
strong solution of the impure drug, and may be em- 
ployed to disinfect and deodorize urinals and closets, 
but cannot be employed to disinfect rooms. It must 
be mixed with the discharges it is intended to neu- 
tralize. 

Pyoktanin (methyl-violet, methyl-blue, blue pyok- 
tanin), an aniline derivative, is a disinfectant and 
antiseptic. It occurs in two colors, blue and yellow, 
the yellow variety being used in ophthalmic practice 
only. Its great disadvantage is that it stains every- 
thing with which it comes in contact. The stains, 
however, may be removed with alcohol or Labar- 
raque's solution. It is used in the form of powder, 
ointment, and in solutions of the strength of i : 500 
and i: 1000. 

Labarraque^ s solution is a solution of chlorinated 
soda, and is made from chlorinated lime and sodium 
carbonate. It is used as an antiseptic in solutions of 
i: 10, and for cleansing purposes. 

Chlorinated lime^ or chlorid of lime, is one of the 
best disinfectants for drains, infected clothes, bowel- 



62 ANTISEPTICS. 

movements, sputum, and urine. It is also a power- 
ful deodorizer. It loses its strength if exposed to 
the air. The standard solution contains 6 ounces 
to I gallon of water. 

Milk of lime is made by slaking lime in water. 
The freshly made solution is used to disinfect typhoid 
stools or urine, but must be thoroughly mixed with the 
infected material to be effective. The disadvantage 
of this solution is its liability to clog the drain-pipes. 

Sidphiiric and hydrochloric acids are employed in 4 
per cent, solutions for the disinfection of excretions, 
equal parts of the solution and the substance to be dis- 
infected being used. 

Zinc chlorid has some value in solution as a de- 
odorizer. 

Ichthyoid derived from fish scales, is a dark brown 
thick liquid, with a highly disagreeable odor ; it is 
used extensively as an antiseptic, astringent, sedative, 
and alterative in many skin diseases, various inflam- 
matory affections, wounds, and abscess-cavities. It is 
employed externally in the form of a thick liquid and 
ointment. Before the application of ichthyol the 
affected parts are washed with warm water and soap, 
and gently dried. After painting, or after inunction, 
the parts are covered with absorbent cotton or flannel 
and gutta-percha tissue. The applications are best 
employed morning and evening. Many patients object 
strongly to its use on account of the disagreeable odor. 
This may be disguised by the addition of oils of citron- 
ella and eucalyptus, i part of each to 50 parts of ich- 
thyol — or ichthyol (9 parts) may be combined with oil 
of turpentine (i part). Ichthyol is said to have a re- 
markably efficacious action upon recent burns in re- 



ANTISEPTICS. 63 

lieving the pain and facilitating healing. It is also 
used in combination with the compound stearate of 
zinc. The stains of ichthyol may be removed by 
boiling the stained articles in soap and water, or by 
washing them with potash-soap or soap-spirit. 

Balsam of Pei'u is used as an external application 
to wounds, 10 to 20 per cent, in castor oil, it having 
both an antiseptic and a stimulant action. Glycerin 
is sometimes used as a menstruum for ichthyol and 
balsam of Peru because of its dehydrating effect 
upon the granulation-tissues of a wound, whereby 
they are held more in check and do not form so 
rapidly. 

Orthoform is an antiseptic and a local anesthetic 
having a decided action when applied to raw sur- 
faces or exposed nerve-endings. It owes its anti- 
septic action to benzoic acid. It is a white, crystal- 
line powder, without odor or taste, entirely non-poi- 
sonous, is slowly absorbed, and is used in the form 
of powder or ointment. In rare cases it causes severe 
inflammation and even sloughing of the skin. 

Orthoform hydrochlorid is a combination of ortho- 
form and hydrochloric acid, and is also an anes- 
thetic. 

Mustard, vinegar, and normal salt solution are also 
antiseptic. 

Sterilized vinegar is said to be equal in antiseptic 
power to a I : 2000 solution of corrosive sublimate. 
It is less irritating to the tissues than bichlorid, and 
is said to stimulate the healing process in open 
wounds instead of retarding it, as mercury some- 
times does. It is sometimes used during an oper- 
ation for irrigation, especially if there is much capil- 



64 ANTISEPTICS. 

lary hemorrhage, which, on account of its astringent 
action, it controls. It is also used for the disinfec- 
tion of the hands, surgical operating-rooms and wards, 
and to remove blood-stains from the hands. 

Mustard is used for the disinfection of the hands 
and arms of the surgeon and his assistants, and of 
the field of operation. After scrubbing the hands and 
arms with a stiff brush and green soap, the water 
used being as hot as can be borne, one teaspoonful of 
mustard is rubbed in very thoroughly for about three 
.minutes, after which it is washed off with hot steril- 
ized water. The field of operation is prepared in the 
same way. 

Resorcin is an antiseptic and deodorant, used in 
the form of solution, powder, or ointment in strengths 
varying from 2 to 20 per cent. As a powder it is 
usually mixed with boric acid, i : 20 or i : 10. It is 
not absorbed by the unbroken skin and produces very 
little irritation on the cutaneous tissues. 

Dermatol^ also called bismuth subgallate, is used 
as a substitute for iodoform in the dressing of wounds. 
It is an antiseptic, sedative, and astringent. 

Protargol is an albuminous compound of silver,, 
containing about 8 per cent, of the metal. It is solu- 
ble in water to the strength of about 50 per cent., 
and forms a clear light-brown fluid. 

Listerine is a proprietary antiseptic solution used 
extensively on wounds, for cleansing the mouth, 
throat, and nose. 

Bicarbonate of sodium has been used with marked 
success as an antiseptic in the treatment of foul sup- 
purating wounds and ulcers in a strength of 2 per 
cent. A i-per-cent. solution has long been used in 



ANTISEPTICS. 65 

which to boil surgical instruments. It is customary 
ordinarily to simply add sufficient soda to impart a 
greasy feeling to the fingers. The soda adds to the 
disinfectant power of the boiling water. 

Soaps have some action as weak disinfectants. 

There are numerous other antiseptics of proprietary 
nature, but it is hardly necessary to refer to them. 
Chemists are constantly adding new preparations to 
the long list already in use. 
5 



PART II. 
SURGICAL TECHNIC. 



CHAPTER VI. 
BANDAGING AND DRESSINGS. 

Believing that nurses will be far more likely to 
practise and to understand the application of the 
various bandages if the directions are set down in a 
terse manner than when wordy descriptions are em- 
ployed, the following section upon bandaging is in- 
tended to be read off while the nurse is actually 
engaged in applying the bandage described. With 
the bandage of proper size in hand she is to begin its 
active application while another directs her move- 
ments by reading from the text (a glance at the illus- 
tration before beginning will aid in securing a well- 
proportioned dressing). It is to be recalled when 
applying the complex bandages that but one edge is 
to show, the rest being covered up by subsequent 
turns. Fears that the bandage is not being correctly 
and neatly applied, because of wrinkles appearing, 
may be discarded if the upper or lower edge (as the 
case may be) is applied sufficiently taut. It may be 
added, too, that frequent turns, each applied moder- 
ately firm, will secure the patient's comfort bettei 
than a few turns tightly set. 

Secure the initial end of a bandage when apply- 



BANDAGING AND DRESSINGS. 6y 

iug by making three circular (overlapping) turns 
about the limb or part which is to be covered. Fasten 
the extremity by means of another bandage, safety 
pins, by tearing up the end in two, reversing and 
tying about the part, narrow^ adhesive strap, or by 
stitching at the crossing points of the bandage. 

Head. — For head bandaging use a roller 2 inches 
wide, 6 yards long. 

Circular Turns. — This bandage may be used to 
cover the forehead, temporal regions, or the sides and 
base of the scalp. 





Fig. 6. — Figure-of-eight of one eye. FiG. 7. — Figure-of-eight of both eyes. 

Circular with Oblique Turns (Figs. 6, 7). — Begin 
this bandage by laying the initial end beyond the site 
of the injury or upon the opposite side of the head. 
May be used to cover one or both eyes ; scalp. 

Circular with Recurrent. — Begin w^ith circular 
turns, then apply the recurrent or refolding turns 
back and forth over the top of the head. Another 
hand is needed to hold the bandage until the final 
circular fixing turns are made. Is used to cover whole 
of scalp (Fig. 8). 

Circular of the Forehead. — This bandage is used to 
cover the occiput, neck, or base of the skull. 



6S 



SURGICAL TECH NIC. 



Circular of the Occiput aiid Forehead (Fig. 9).— 
This bandage is applied by making a reverse over the 
temporal region from the crown to the under jaw 
after passing the first turns. It covers the lower jaw 
and the parotid region. 





Fig. 8. — Recurrent bandage of 
the head. 



Fig. 9. — Crossed bandage of the 
angle of the jaw. 



Circular. — From the occiput to the forehead, re- 
versed over the temporal region ; then circular and 
oblique turns from the crown to the under jaw. It 
covers the cheek and side of the face. 





Fig. 10. — Barton's bandage, or figure- FiG. ii. — Gibson's bandage, 
of-eight, of the jaw. 

Barton'' s (Fig. 10). — This is used for fracture and 
dislocation of the jaw. It is made with figure-of- 
eight turns, beginning just behind the mastoid proc- 



BANDAGING AND DRESSINGS. 



69 



ess with alternating circular turns from the occiput 
to the chin. 

Modified Barton^ s is used to obtain greater security. 
Add circular turns from the occiput to the forehead. 

Gibson' s (Fig. 11) is used for fracture or dislocation 
of the lower jaw. Three circular turns are made 
from the crown (vertex) to the lower jaw ; reverse 
and make three circular turns over the temporal re- 
gion, from the occiput to the forehead, then three 
circular turns from the occiput to the chin ; reverse 
and make a last turn from the occiput to the forehead. 





Fig. 12. — Four-tailed bandage for 
the jaw. 



Fig. 13. — Griffith's head bandage. 



Handkerchiefi or Four-tailed Bandage {^\.^. 12). — 
This is used for fracture or dislocation of the lower 
jaw, to retain dressings. 

Griffith'^ s Head Bandage (Fig. 13). — A simple re- 
taining bandage for dressings about the angles of the 
jaw and adjacent neck region may be made from a 
yard length of a three- or four-inch roller. The 
bandage is applied by laying it against the dressing 



70 SURGICAL TECH NIC. 

in place. The ends are then drawn up upon each 
side of the patient's head. A two-tailed end is made 
from each by tearing down the middle until the level 
of the lobe of the ear is reached. The four tails are 
then to be drawn taut, crossed, and tied over the vertex. 

Neck. — For this bandage use a roller 2 inches 
wide, 5 yards long. 

Circular. — Circular with oblique turns. Circular 
with figure-of-eight turns about the axilla (Fig. 14), 




Fig. 14. — Figure-of-eight bandage of neck and axilla. 

They are used to retain dressings to the neck or 
axilla. 

Chest. — Roller 3 inches wide, 10 yards long. 

Spiral Bandage of the Chest. — This bandage is 
used to secure dressings to the chest, temporary dress- 
ing for fracture of the ribs. It is made by applying 
circular turns with oblique (spiral) turns until the 
chest is covered ; a final turn is made for support over 
the shoulder and down the front of the chest. 

Anterior Figure-of-eight Turns. — This is used to 
cover the front and upper parts of thorax. It is 
formed by circular turns from the axilla across the 
chest (to fix the bandage) ; figure-of-eight turns from 
behind the shoulder up and over, crossing anteriorly 
to the other side of the body. 



BANDAGING AND DRESSINGS. J\ 

Posterior Figiire-of-eight Turns. — Used for fracture 
of the clavicle or dislocation. To hold dressinofs to 
back of the chest. Oblique turns from one shoulder, 
across the back to the opposite axilla, thence anterior 
up and over the shoulder with figure-of-eight turns to 
the other side of the body. 

Bandage for Sttpport and Compression of the Breast 
(Fig. 15). — Circular turns (oblique) from the scapula 
of the sound side, across the back, to axilla, beneath 
the breast, over the shoulder to point of starting. 
Alternate with circular turns about the thorax. By 
repeating the turns for the other side both breasts may 
be supported. 





Fig. 15. — Figure-of-eight bandage of FiG. 16. — Gauntlet bandage, 

the breast. 

Upper Bxtremity.— For these bandages use a 
roller 2J inches wide, 7 yards long. 

Roller 2 inches wide, 6 yards long, for hands, 
wrist, and elbow. 

Fingers. — Roller i inch wide, 3 yards long for 
fingers. 

Circular with Oblique (Spiral) Ttirns. — Used to 
retain dressings or splints. For additional support 
apply one or two circular turns to the wrist. 

Gauntlet Bandage of the Hand (Fig. 16). — It is 



72 SURGICAL TECHNIC. 

used to cover back of hand and all of the fingers. It 
is made by circular turns to the wrist (fixes), oblique 
turn across the back of the hand to the little finger ; 
cover in by circular, oblique (spiral), and recurrent 
(refolding) turns ; when necessary to cover up the ends 
of the fingers, return to the wrist by an oblique and 
circular turn ; cover remaining fingers and the thumb. 
Complete by a circular turn to the wrist. 

Back of Hand {Demi-gatnitlet) (V\g. 17). — Used to 
secure dressings to either the back or palmar (by re- 
versing) surfaces of the hand. Fix by circular turns 
about the wrist. Continue with an oblique turn 





Fig. 17. — Demi-gauntlet bandage. FiG. i8. — Spica of the thumb. 

across the back of the hand to the base of the little 
finger, circle the finger, return to the wrist. Com- 
plete by similar turns to the remaining fingers and 
thumb with a final circular turn of the wrist. 

Spica of Thumb (Fig. 18). — Used to retain dressings 
or splints to this part. Circular turns of the wrist to 
fix. Continue by an oblique turn to the tip of the 
thumb, circular with an oblique turn to the wrist. 
Continue by repeating until the thumb is entirely 
covered. Complete by a circular turn around the 
wrist. Cover the end of the thumb by recurrent (re- 
folding) turns when necessary. 



BANDAGING AND DRESSINGS. 



73 



Spiral Reversed of the Upper Extremity (Fig. 19). 
— Used to cover the arm, forearm, and hand. Fix 
by circular turns at the wrist. Cover the hand by 
circular and oblique turns (spiral or spiral reversed) ; 
with figure-of-eight turns about the base of the thumb 
and the wrist. Cover the arm by ascending circular 
with oblique (spiral reversed and spiral) turns to the 
elbow which is covered in by figure-of-eight turns. 
Complete by circular (oblique, spiral, and spiral re- 
versed) turns to the axilla. 





Fig. 19. — Spiral reversed bandage of 
the upper extremity. 



Fig. 20. — Figure-of-eight bandage 
of the elbow. 



Figure-of-eight of Elbozv (Fig. 20). — Used for dress- 
ings about the elbow. Allows motion without de- 
rangement of the dressing. Fix by circular turns 
just below the elbow. Continue by an oblique turn 
across the front of the joint to the upper arm. Com- 
plete by circular turn with a return across the joint 
to the starting-point. Continue, overlaying two- 
thirds of the previous turn laid down, until the parts 
are entirely covered. 

Spica of the Shotilder {Desce7idi7ig). — Used to retain 
splints and dressings about the shoulder. Circular 
turns about the arm at the level of the axilla (to fix) ; 
oblique turn across the shoulder, base of the neck, 
about the opposite axilla to the back. Complete the 
turn by crossing the first turn at the base of the neck. 



74 SURGICAL TECHNIC. 

Continue until the parts are covered (each turn over- 
lapping two-thirds of the previous one). 

Spica of the Shoulder (Ascending) (Fig. 21). — This 
bandage is made by circular turns around the arm at 
the level of the axilla (to fix). Continue by an oblique 
turn across the chest to the opposite axilla, return 
across the back to starting-point. Continue by re- 
peating these turns (ascending by overlapping pre- 
ceding turns two-thirds). 





Fig. 21. — Ascending spica of the shoulder. FiG. 22. — Velpeau's bandage. 

Velpeaic Bandage (Fig. 22). — This is used for fract- 
ure of the clavicle and scapula and for dislocation of 
the humerus. Place the fingers of the affected side 
upon the sound shoulder (prevent the skin surfaces 
coming in contact by means of gauze, towel, dusting- 
powder). Commence the application of the bandage 
from the scapula of sound side, continue with a turn 
over the shoulder of the affected side, anteriorly down 
the arm, behind the elbow ; across the front of the 
chest to the sound axilla ; thence to the point of 
starting. Repeat (to fix). After the second turn 
carry the bandage transversely around the chest, over 
the flexed arm, near the elbow. Continue by alter- 
nating circular turns (ascendii^g spirally) with turns 
similar to the fixation turns. 



BANDAGIXG AND DRESSINGS. 



75 



Desault Bandage. — Used in fracture of the clavicle. 

First roller (Fig. 23) : Elevate slightly the arm of 
the affected side ; place a pad in the axilla, secured 
by circular turns (spiral) with figure-of-eight about 
the opposite shoulder (to fix). Complete by covering 
in the chest with circular oblique turns. 




Fig. 23. — Desault's bandage, 
first roller. 




Fig. 24. — Desault's bandage, 
second roller. 



Second roller (Fig. 24) : Lower the arm of the 
affected side; flex the forearm (to a right angle) across 
the front of the chest. Bind the arm to the chest by 
circular turns (spiral) from the shoulder to the elbow. 




Fig. 25. — Desault's bandage, third roller. 



Third roller (Fig. 25) : Forms two triangles if cor- 
rectly applied (an anterior and a posterior). Oblique 



7^ SURGICAL TECHNia 

turns beginning in the axilla of the sound side, thence 
across the chest to the shoulder, around the shoulder 
to beneath the elbow. Return to starting-point. Re- 
peat, alternating in front and behind. Complete the 
dressing by applying a sling. 

Abdomen. — For abdominal bandages use a roller 
4 inches wide, 9 yards long. 

Circular with Spiral Turns. — Binder ; many-tailed 
binder (9 to 18 inches wide, i to 2 yards long). .Used 
to secure dressings, and for support of the parts. 

I/Ower :^xtremity.— Use a roller 3 inches wide, 9 
yards long. 

Spica of the Grohi {Asce7tding). — Used to secure 
dressings to the groin, upper portion of the thigh. 
Circular turns around the. thigh (to fix). Continue 
by oblique circular turn just below the crest of the 
ileum of the sound side. Return to the starting- 
point. Repeat, ascending and covering two-thirds of 
the previous turn. 

Spica of the Gj^oin {^Descending). — Made by circular 
turns about the thigh, high up (to fix). Continue by 
a circular oblique turn to the crest of the opposite 
ileum. Complete by returning to the affected side, 
crossing the first turn in the middle of the thigh. 
Repeat by circular oblique turns, descending by over- 
lapping two-thirds of the previous turn. 

Figure-of-eight Bandage of the Groin (Fig. 26). — 
An emergency or provisional bandage may be quickly 
applied to the groin by passing the end of a three- 
inch roller bandage about the body above the hips. 
Cross the ends over the center of the groin and re- 
verse them, one passing above the thigh, the other 
behind to be tied upon the outer aspect of the limb. 



BANDAGING AND DRESSINGS. 



77 



Double Spica of the Groms (Fig. 27). — Made by 
circular turns about the abdomen above the crests of 
the iliac bones. Continue by an oblique circular turn 
to and around the left thigh, across to the back of the 
abdomen, anterior with an oblique turn to the inner 





Fig. 26. — The Pryor inguinal bandage. FiG. 27. — Double spica of the groins. 

side of the right thigh, circular turn ; mount obliquely 
to the opposite side of the abdomen. Repeat until 
both groins are covered, overlapping two-thirds of 
previous turn at the crossing line in the middle of 
the thighs. 

Knee. — Roller 2\ inches wide, 5 yards long. 

Figure-of-eight Bandage of the Knee, — Used for re- 
taining dressings about the knee. Circular turns (3) 
about the leg below the knee (to fix). Continue by 
an anterior oblique turn across the front of the knee, 
mounting to the thigh ; circular turn about the thigh ; 
return by recrossing the knee, descending with an ob- 
lique turn. Repeat, overlapping previous turns two- 



78 



SURGICAL TECHNIC, 



thirds at the midline. Complete by covering in the 
parts entirely, finishing with circular turns. 

Figure-of-eight Bandage of Both Knees. — Used as 
a temporary dressing for fracture or dislocation of the 
thighs. 

Circular turns about the legs at the level of the tops 
of the calves (to fix). Continue by rising obliquely 
across the front of the knees to the thighs ; finish 
with a circular turn ; return to the starting-point by 
a descending oblique turn across the front of the 
knees. Repeat, covering in two-thirds of the pre- 
vious turns until the parts are entirely covered. Com- 
plete by right-angled turns about the bandage, by 
passing between the legs and thighs. 

Foot. — Use a roller 2J inches wide, 6 yards long. 

Spica of the Foot (Fig. 28). — This bandage is used 
for sprains, and as a dressing to the foot. Circular 




Fig. 28. — Spica of the 
instep. 



Fig. 29. — Method of 
covering the heel. 



Fig. 30. — Figure-of-eight 
bandage of the instep. 



turns (3) about the ankle (to fix) ; descend by an ob- 
lique turn across the back of the foot to the base of 
the toes, circular turn ; cover the foot by ascending, 
oblique, spiral reversed turns until the instep is 
reached. Continue by oblique turns, covering in the 



BANDAGING AND DRESSINGS. 79 

heel. Complete by ascending, oblique, circular turns 
above the ankle. 

To Cover the Heel {American Method) (Fig. 29). — 
Circular turns (3) about the ankle (to fix) ; descend by 
oblique turn across the back of the foot ; circular 
turn at the base of the toes. Continue by covering 
the foot with ascending spiral reversed turns until the 
instep is reached. Cover the heel by circular turns 
from the instep to the heel, alternating with figure-of- 
eight turns about the sides of the heel. Complete by 
circular turns, ascending the ankle. 

Bandage of the Foot Not Covering the Heel {French) 
(Fig. 30). — Circular turns (3) at the ankle (to fix). 
Oblique turn across the back of the foot, descending 
to the base of the toes, where a circular turn is made. 
Cover in the foot to the instep with spiral reversed 
turns (ascending). Complete by circular turns about 
the ankle and lower leg. 

Complete Bandage of the Lower Extrem,ity (Fig. 
31). — This bandage is used for applying compression 
to the leg to retain dressings. Circular turns (3) at 
the ankle (to fix) ; oblique turn, descending across the 
dorsum of the foot, with a circular turn at the base 
of the toes. Continue by covering in the foot and 
heel. Ascend the leg by circular, oblique, spiral, or 
reversed spiral, covering in the calf Continue by 
figure-of-eight turns at the knee. Complete by as- 
cending spiral or reversed spiral of the thigh. 

Fignre-of eight of the Leg. — This bandage is used 
to secure compression ; it is not easily disarranged. 
Circular turns (3) about the ankle (to fix). It is made 
by oblique turn across the dorsum of the foot ; circu- 
lar turn at the base of the toes. Continue by cover- 



8o 



SURGICAL TECH NIC. 



ing in the foot. Ascend the foot to the ankle with 
oblique, spiral reversed turns. Ascend the leg to the 
top of the calf by an oblique turn across the front of 
the shin. Continue with a circular turn just below 
the knee ; return to the ankle, crossing the previous 
turn on the line of the shin.. Complete by repeating 
the oblique turns, covering two-thirds of the previous 
turn as you mount the leg. Finish with a circular 
turn just below the knee. 





Fig. 31. — Spiral reversed bandage 
of the lower extremity. 



Fig. 32. — Recurrent bandage 
for a stump. 



Recurrent Bandage for a Stump (Fig. 32). — Roller 
2J inches wide, 6 yards long. Circular turns near 
the lower end of the stump (to fix). Ascend with 
oblique circular turns. Continue by recurrent (refold- 
ing) turns, covering the end of the stump. Complete 
by ascending oblique, spiral, or spiral reversed turns, 
overlapping two- thirds of the previous turn. 

Spiral Reversed Bandage of the Penis. — Roller i 
inch wide, i yard long. Circular turns at the peno- 
scrotal junction (to fix). Continue by an oblique turn 
to the glans ; circular turns. Ascend the body of the 



BANDAGING AND DRESSINGS. 



8i 



penis by oblique, circular, or reversed spiral turns. 
Complete by circular and figure-of-eiglit turns about 
the base of the penis and scrotum. 

Bandage for Secitrmg the Lithotomy Position. — 
Roller 2\ inches wide, 4 yards long. Bring the 
patient's hand down to the side of his foot. Circular 
turns (3) around the wrist and ankle (to fix). Con- 
tinue by alternating circular turns about the wrist 
and ankle. Repeat with the hand and foot of the 
opposite side. A rolled sheet twisted from opposite 




Fig. 33. — Perineal binder. 

comers, passing under one shoulder, over the other, 
and beneath the patient's knees, drawn up to his 
chest and tied, will answer the same purpose. 

Peri^ieal Binder for Retaining Dressings to Peri- 
neum (Figs. 33, 34). — Roller 8 inches wide, 4 feet 
long. 

LiebreicK' s Eye Bandage (Fig. 35). — Strip of flan- 
nel, white or black, 2J inches wide, 8 to 10 inches 
long, fitted with tapes at the extremities. Apply to 



82 



SURGICAL TECHNIC. 



one eye obliquely, reverse the tapes by crossing at tbe 
occiput, circular turn, and tying. Apply to both 
eyes transversely with circular turn of the tapes and 
tie. 





Fig. 34.- — Perineal binder in position. FiG. 35. 



-Modified Liebreich's 
eye bandage. 



In addition to the well-known roller-bandage, spe- 
cial bandages find frequent employment, particularly 
after abdominal operations. The most important are 
the Scultetus and the T-bandages. 

The Scultetus^ or many-tailed, bandage is used for 
surrounding the abdomen. It is made of two pieces 
of flannel or of cotton, each i yard long and 4 inches 
wide, the two pieces being placed 4 inches apart ; across 
them are sewed five other pieces of the same length and 
width, each piece being overlapped by the one above 
it by one-half its breadth. This bandage is placed 
under the patient's back, the cross-strips are folded 
over the abdomen from below upward, and the lower 
ends of the vertical strips are brought up between 



BANDAGING AND DRESSINGS. 



83 



the thighs and pinned to the front of the bandage. 
This keeps the bandage from wrinkling and retains it 
in position. Greater security will be obtained in 
male patients if the tail be torn half way down its 
middle, the two strips being then brought up over 
each groin space. A simple form of this bandage 
may be made from a width of flannel i yard long. 
Placed smoothly beneath the patient's back, its ends 
are torn nearly through in strips or tails, each 6 or 8 
inches wide. It is applied by overlapping and alter- 
nating the tails, which are to be then snugly fastened 
with safety pins or adhesive straps. 




Fig. 36. — The Scultetus bandage. 



Fig. 37. — T-bandage. 



'X -bandage. — The T-bandage, which is used to se- 
cuie dressings on the anus or the perineum, is made 
up of two strips of bandage, each about 5 inches 
wide. To the middle of one strip, which is to go 
around the waist, the end of the other strip is sewed, 
which forms a letter T. This latter strip is brought 
forward between the thighs and pinned to the front, 
thus securing the perineal dressing. 

Splints^ padded with cotton-batting, oakum, wool, 



84 



SURGICAL TECHNIC, 



or hair, may be constructed from white pine, poplar, 
or willow wood, ^ to J inch (3-12 mm,) in thickness, 
cut to measured length and width ; they may be of 
pasteboard or binder's board, molded to shape by 
soaking in boiling water, or of raw-hide similarly 
worked ; of felt ; plaster of Paris ; starch (dissolved in 
cold water, after which boiling water is added until the 
proper consistence is secured) requires from twelve to 
forty-eight hours to dry thoroughly (Fig. 38) ; gum 
and chalk (equal parts of gum arable and precipitated 




Fig. 38. — Splint made from plaster-of-Paris bandage. Complete by mold- 
ing to the part ; trim after setting has taken place. 

chalk, add sufficient boiling water, stirring to obtain 
a proper consistence of solution), applied upon band- 
ages ; hatter's felt or binder's board may be softened 
in hot water and molded to the injured parts. The 
coaptation splint consists of thin and narrow board 
strips (of bass wood or pine) placed in position (side 
by side, with a slight interval) upon a sheet of adhe- 
sive plaster, or they may be quilted between two 
pieces of sheeting. The splint is held in position by 
bandaging or by adhesive straps, and may be em- 



BANDAGING AND DRESSINGS. 85 

ployed in emergency or to reinforce the ordinary 
board or bracket splint. Fracture-box consists of a 
stout board 6 to 8 inches (15-20 cm.) wide by 18 to 30 
inches (45-75 cm.) long, with hinged sides, a foot- 
board, upright, firmly attached at right angles to the 
bottom board, padded with a pillow, cotton-batting, 
or bran ; may be used in treating fractures of the 
lower leg and knee. Bags made from stout muslin 
or light duck canvas cut 14 inches (35 cm.) wide by 
3 feet (90 cm.) to 5 feet (1.5 ni.) long, doubled, sewed, 
and inverted before filling with sand or bran, closed 
wath a draw-string or by stitching, are employed in 
fractures of the leg and thigh. Compresses to pre- 
vent displacement may be made of cotton, lint 
(folded), oakum, and held in place by adhesive straps, 
bandage, or placed upon splints when padding. 

Prevent infection of the soft parts from maceration 
of the skin surfaces after fracture by a thorough 
cleansing of the parts before applying the first per- 
manent dressing and by " alcohol rubs " at each sub- 
sequent dressing. Neuralgic pain in the region after 
fracture is due to organized blood-clot or exudate. 
Treat by massage. Swelling, loosening, infection, 
malposition of the parts will demand an examination 
or change of dressings and correction by the surgeon. 



CHAPTER VII. 

CARE OF OPERATINQ=ROOM; METHODS OF 
STERILIZATION ; CARE OF INSTRUMENTS. 

In almost all large hospitals there are three operat- 
ing-rooms, one for general surgical, one for gyneco- 
logic, and one for septic operations. 




Fig. 39. — Kny-Scheerer instrument cabinet, having adjustable shelves 
and a plate-glass partition in the center, which practically, divides it into two 
closets. 

The operating-room for septic cases should be far 
removed from the others, and neither surgeon nor 
nurse attending this room should have anything to 

86 



STERILIZATIO.y. 



87 



do with the others. Rooms should also be set apart 
exclusively for dressing the cases, thus extending the 
benefit of an isolation of operating-rooms and adding 
greatly to the convenience of hospital work. 




Fig. 40. — Griffith's hook for use in glass-shelved instrument cases. 

These dressing-rooms are otherwise ver}' desirable, 
for besides having everything at hand with which to 
do a dressing properly, the nurse in charge of the 




Wiieeled stretcher. 



patient has the opportunit}- to turn and make up the 
bed afresh during the patient's absence. Stretchers 
are used to convey patients to and from the operating- 
and dressing-rooms. The wheels generallv have 



88 SURGICAL TECHNIC. 

rubber-tires, the top-board is detachable and has four 
handles, two at each end. At least four stretchers 
are necessary in a large hospital. 

The material used in the construction and furnish- 
ing of an operating- and dressing-room should be of 
marble, metal, porcelain, and glass, all of which can 
readily be made aseptic. The water- faucets should 
be controlled by automatic foot- or elbow-valves, so 
as to avoid contamination by turning on the spigots 
with the hands after they have been rendered aseptic. 

The operating-room should be kept clean, and 




Fig. 42. — House-stretcher. 

should be damp-swept and wiped every day ; in short, 
it should be in such a condition as to be ready for an 
operation at a few moments' notice. The supplies for 
dressings should not be allowed to run down, and the 
instruments should always be in a first-class condition. 
An emergency bundle, containing everything neces- 
sary for an emergency operation, should be kept in 
readiness. 



STERILIZA TION. 




==-- ,i l m -, ^ 



Fig. 43 — Improved model sterilizer. 

Sterilisation. — Sterilization may be either dry or 
moist ; moist heat is preferable, because it is more 
thorough and more penetrating than dry heat. For 



90 



SURGICAL TECHNIC. 



dry sterilization the towels and dressings are placed 
in covered tin pans in an oven the temperature in 
which ranges from i6o° to 212° F. For moist or 




Fig. 44.— Sterilizing tube for edged instruments. 

Steam sterilization, a Kellogg, a Sprague, or an Arnold 
steam sterilizer is used. The heat must be continued 
for fully one hour before the operation. 

Regarding the sterilization of instruments surgeons 





Fig. 45. — Arnold sterilizer. 



Fig. 46.-^Formalin lamp. 



differ; some prefer to have their instruments wrapped 
in a towel and put into the Schimmelbusch or Arnold 
sterilizer and allowed to boil for half an hour in a i 
per cent, solution of carbonate of sodium to prevent 



Plate i. 




STERILIZA TION. 



91 



their rusting. The water must boil before the instru- 
ments are placed in it. All edged instruments to be 
boiled in the soda solution should be wrapped in cot- 
ton and packed so firmly that they will not be tossed 
against one another by the solution as it becomes 
agitated in boiling. This agitation seems to be the 
reason why they lose their edge. Many operators 
prefer to have their edged instruments and needles 
placed in a dish containing 95 per cent, carbolic acid 
for half an hour; then just before the operation they 
are taken out and rinsed with sterilized water. 



-^ 






Fig. 47. — Sterilizer for instruments and dressings. 

After sterilization the instruments are transferred 
to the instrument-table, or to shallow porcelain or 
glass trays, in which they lie covered with sterilized 
towels until required. 

Instruments and dressings are now sterilized with 
formaldehyd with excellent results, one great advan- 
tage being that neither the solution of formalin nor 
the gas injures the instruments in any way or dulls 



92 



SURGICAL TECH NIC. 



the edge of knives, scissors, or needles. A Schering 
lamp is usually used either with a 40-per-cent. solu- 
tion of formaldehyd or with formalin pastils. The 
best results seemed to be obtained with the pastils. 
One pastil is constantly being evaporated in the upper 
cup of the lamp ; but when rapid evaporation is re- 
quired the upper cup is removed and the pastils are 
placed in the lower part. 




Fig. 48. — Latest form of complete sterilizing outfit for dressings, A\-ater, in- 
struments, sheets, towels and operating gowns, basins, and trays. 

After the operation the instruments should be 
taken apart, washed in cold water to remove all 
blood, pus, and tissue-particles, and then thoroughly 
scrubbed with green soap. Instruments with perma- 
nent joints, which fortunately are seldom seen now, 
must receive special attention, since it is difficult to 
get them surgically clean. After being scrubbed the 
instruments are rinsed in hot sterilized water, wiped 



Plate 2. 






o 
o 

& 

o' 

o 
Q 

s 

cra_ 
o' 

o 



1^ 



.mm 



._-™„C„_ 




STERILIZATION. 93 

dry with a soft towel, locks oiled, and then laid away 
in the case. The knife-blades must be rolled in 
cotton. The important points to be remembered in 
cleaning instruments after an operation are : 

First, all instruments that can be so dealt with 
must be taken apart and the rough catches thoroughly 
cleansed. 

Second, they must be dried carefully in order to 
prevent rusting; for instruments once rusted seem 
always to have a tendency to return to that condi- 
tion. 

Instrument-trays are made of glass, porcelain, agate- 
ware, or hard rubber; and are rendered aseptic by 
being first scrubbed with green soap and warm water^ 
after which they are filled to the brim with i : 500 cor- 
rosive sublimate, which is allowed to remain in them 
for half an hour. When needed they are rinsed with 
salt solution or sterile water. Many surgeons prefer 
the trays filled with enough sterile water to cover the 
instruments, while others again prefer the instru- 




FlG. 49. — Glass instrument tray. 



ments to be laid dry on the glass table, which has 
been previously covered with a sterilized sheet or 
towels. 

Every operating-room nurse should be familiar 
with the names of the instruments necessary for 
each different operation, so as to be able to lay them 
out when occasion requires. Many nurses get to- 



94 



SURGICAL TECHNIC. 



gether after school-hours and "make believe" an 
operation is to take place. Each nurse has her duty 
assigned to her, and each tries to fulfil it in a thor- 
oughly professional, dignified, and quiet manner. 
Practice of this kind is never lost. 





Fig. 50. — Glass hand bowl. 



Fig. 51. — Pus basin. 



In the operating-room should be kept two large 
ledgers, in one of which the house-surgeons, after 
making the morning rounds with the visiting sur- 
geons, should record the number of operations to be 
performed the next day, the time, name of operator, 
etc. The operating-room nurse is thus made ac- 
quainted, by consulting the book, of the amount of 
work before her for the next day, and the character 
of the operations for which she has to prepare. 




Fig. 52. — Robb's aseptic ligature-tray ; white porcelain 



On the morning of the operations she makes out a 
list of the floor and number of private room or letter 
of ward and number of bed, from which the patients 
are to be brought to the operating-room, and the order 



STERILIZA TION. 



95 



in whicli the operator wishes them. This list is. given 
to the male attendant, who brings up the patients in 
succession, in such a way that while one patient is 
being operated on the next is being anesthetized. The 
head nurse in the operating-room has two or three 
sets of instruments, and during one operation an as- 
sistant nurse is sterilizing the instruments and making 
preparations for the next operation. There is then 
no waiting on the part of the operator, for as the 
patient operated on is wheeled out of the operating- 
room the next patient is wheeled in. The following 
chart will give an idea as to the way the book is made 
out and the order in which the operations are writ- 
ten. The emergency-operations, accidents, etc., are 
also recorded, but after the performance of the ope- 
ration. 



Date. 


Operation. 


Floor.l 


Time. 


Operator. 


Room 


Ward. 




Floor. 


Mar. 11. 


Laparotomy. 

Vaginal hysterec- 
tomy. 
Cholecystostomy. 
Appendicectomy. 

Amputation, breast 


4th. 


8. A M. 

8.30 " 
9.00 " 


Dr. Murphy. 
" Johnson. 


19 
21 
24 






3d. 






9-30 " 
10.00 " 
IO-45 " 
11.30 " 


" Fenger. 
" Morgan. 
" Kindig. 
" Carter. 


16 


B 
D 
D 


TO 

6 
Q 


C( 




Appendicectomy. 
Cesarean section. 
Appendicectomy. 


3d. 


2. P.M. 

3 00 " 
4.00 " 
6.30 " 


" Andrews. 
" Fenger. 
" Eyster. 
" Comegys. 


24 
21 
21 
29 






4th. 

2d. 

4th. 
2d. 



The second book gives the date on which the 
patient was prepared for operation, by whom pre- 
pared, etc. , as, for example — 

* Clean operating-room, fourth floor ; septic, third floor. 



SURGICAL TECHNIC. 



Date of 
Preparation. 


Prepared by 


Antiseptic 
used. 


Operator. 


Floor. 


Room. 


March lo. 


E. A. S. 


Corros. sub. 


Dr. Eyster. 


Fourth. 


No. 21. 


Date of 
Operation. 


Hour. 


Sutures 
used. 


Length of 
time prepared. 


Stitches 
removed. 


Condition. 


March ii. 


4 p. M. 


Silkworm- 
gut. 


Two hours' 
boiling. 


March 19. 


Aseptic. 



A book should also be kept in each dressing-room 
showing the number of cases dressed each day, the 
dressing used, and progress since the last dressing. 
It should be kept for the convenience of the dressing- 
room nurse in making an estimate of dressings for the 
next day, and for the convenience of the surgeon in 
knowing what patients are dressed, their condition, 
and in knowing when they are to be again dressed. 
It will also recall condition of last dressing. 



Room or 
Ward 



No. 29, 
2d floor. 



Diagnosis. 



Appendicitis. 



Operated. 



March 11. 



Operator. 



Dr. Come- 

gys. 



Dressed. 



March 17. 



Died or 
Discharged. 



Discharged 
April 2. 



Remarks. 



CHAPTER VIII. 

INSTRUMENTS NECESSARY IN DIFFERENT OPE= 
RATIONS, KEEPING OF CHARTS, SURGEON'S 
KIT, ETC. 

In many hospitals, small ones especially, where 
there are no medical students or house doctor, the 
nurse has more responsibility than in larger institu- 
tions, and becomes closely familiar with such details 
as taking the history of the patient; the arranging 
and sterilization of instruments; assisting the oper- 
ator, giving the anesthetic, and writing out the re- 
port of the operation. The following charts will be 
of use in keeping the important features of this line 
of duty in mind. When taking the patient's history 
it is a good plan to allow her to describe her con- 
dition in her own words. Any peculiarities of the 
patient's manner and other points which may be 
observed can be noted, and afterward the questions 
necessary for making out the charts may be asked. 

Family History. 

Age. Health. Disease. Cause of death if dead. 

Father. 

Mother. 

Brothers (number). 

Sisters (number). 

Wife or husband. 

Children (number). 

Uncles or aunts with epilepsy, insanity, tuber- 
culosis, or consumption. 
7 97 



98 SURGICAL TECHNIC, 

Personal History. 

When born. Where lived. Peculiarities of cli- 
mate. Occupations. Habits (as to eating, 
drinking, sleeping, etc.). Appetite. Condi- 
tion of bowels. Nervousness. Culture. 

(When Female.) 

Sexual History. 

I. Menstruation. 

(a) First at what age. 
(b^ Regularity. No. days. 
{c) Duration. No. days. 
(d) Amount. 

r Color. 

{e) Character of discharge J Consist- 

I ency. 
[ Odor. 

(/") Intermenstrual discharge. 

i^g) Dysmenorrhea — when. 

II. Pregnancies \ ^. . ' ... 

I Sickness or peculiarities. 

c Number. 

III. Miscarriages I Sickness. 

l Fever. 

IV. Labors. 

(a) Number. 

^ Easy. 
Difficult. 
Spontaneous. 
Instrumental. 
{c) Peculiarities. 
(</) Sickness post partum, if any. 

Previous Illness. 

Starting with childhood, give different sicknesses 



(3) Character 



SURGEON'S KIT. 99 

and age at which same occurred, following life 
of patient to present time simply with reference 
to sickness, including appetite, bowels, urine, 
headaches, pains, coughs. 

Present Sickness. 

Date. 

Onset. Character, j ^^^^^^.> P^^^^' locations, se- 
I verity, etc. Peculiarities. 
Progress and changes to present time. 

Changes. Appetite. Bowels. Urine, etc. 
Examination. 

The packing of a surgeon's bag is often done by 
the operating-room nurse. Many surgeons use the 
telescope valise, or kit, as it is more commonly called; 
while others emplo}' a regular surgeon's bag. Be- 
fore the bag is packed the nurse makes out the list of 
necessary articles, and as each article is put in it is 
checked off the list. When packed, a copy of the 
list is securely pinned upon a towel inside, where the 
surgeon can see it on first opening the bag. The kit 
is packed by first laying in two large sterilized 
towels, the ends of which hang over the edges of the 
bag. Together with the instruments, which are 
placed in a linen instrument-roll, and the dressings, 
the kit should contain three new nail-brushes, soap, 
razor, oxalic acid and permanganate of potassium 
crystals in bottles, hypodermic syringes with tablets 
of strychnin sulphate (gr. ^), atropin sulphate (gr. 
t^-o), and morphin sulphate (gr. -|), cocain hydro- 
chlorate (gr. J), ether and chloroform (with cone and 
mask), tablets of corrosive sublimate and sodium 
chlorid, iodoform gauze, plain gauze, gauze sponges, 
white suits, caps and canvas shoes for the operator 



lOO 



SURGICAL TECH NIC. 



and assistants, Kelly pad, rubber gloves, brandy, 
alcohol, safety-pins, absorbent cotton, twelve towels, 
a rubber apron, ligatures, sutures, and rubber and 
glass drainage-tubes. The glassware should be packed 
in the middle, to prevent breakage. When the kit is 



laiiiiiii 




IMMMlMi 



Fig. 53. — Canton-flannel roll for instruments. 

packed a third towel is laid over the contents, the 
edges of the other two are brought up, and all pinned 
together with safety-pins. 

The instrument-rolls are very serviceable in econo- 
mizing space and in keeping the instruments aseptic. 




Fig. 54.— Instruments wrapped in canton-flannel roll. 

They are made of linen, canton flannel, or toweling, 
one yard long ; and through the middle of each are 
adjustable loops in which the instruments are placed. 
When soiled the rolls may be washed and sterilized. 



OPERATION BLANK. lOI 



OPERATION BLANK* 



Service of Dr. 
Bate. March 10, 1899. 
JYame 



I. PREPARATION OF PATIENT FOR OPERATION. 

II. ANESTHETIC. ANESTHETIST. 
Temperature. 

Before operation. 
After operation. 
Pulse and Respirations. — To be taken continuously 
during operation. 

III. PREPARATION OF FIELD OF OPERATION. 

IV. POSITION OF PATIENT DURING OPERATION. 
V. PRIMARY MANIPULATIONS. 

VI. INCISION AND HISTORY OF OPERATION. 
VII. TREATMENT OF WOUND. 
VIII. DRAINAGE. 
IX. CLOSURE OF WOUND. 
X. DRESSING. 

XL RECOVERY FROM ANESTHETIC 
XII. AFTER-TREATMENT. 









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102 



LIST OF INSTRUMENTS. IO3 

LIST OF INSTRUMENTS NECESSARY IN DIFFERENT 
OPERATIONS. 

Instruments for Geiieral Anesthesia. 

Inhalers for gas, ether, chloroform. 

Wooden mouth-wedge and gag. 

Tongue forceps. 

Hypodermic syringe and needle. 

Anesthetizing stethoscope. 

Throat swabs. 

Instruments for Local Anesthesia. 
Two glass hypodermic syringes. 
Two medicine glasses, one to hold cocain solution, 
the other for weak, sterile soda solution. 
Extra needles and cleaning wires. 

Instruments for Perineorrhaphy. 



Catheter, glass, small. 


I 


Catheter, glass, large. 


I 


Forceps, hemostatic, small. 


6 pairs. 


Forceps, hemostatic, intermediate, 


3 '' 


Forceps, hemostatic, long. 


3 '! 


Forceps, hemostatic, long dressing-. 


I pair. 


Forceps, hemostatic, tissue- (rat-tooth). 


2 pairs 


Forceps, hemostatic, bullet-, 


2 " 


Forceps, hemostatic, volsella. 


2 '* 


Scalpels, 


2 ** 


Uterine sound and applicator. 




Tenacula, straight, 


I pair. 


Tenacula, curved, 


2 pairs 


Tenacula, shepherd's crook, 


I pair. 


Scissors, straight. 


I '' 


Scissors, right-angle. 


I ** 


Scissors, left-angle. 


I " 



I04 SURGICAL TECHNIC. 

Sponge-holders, 6 pairs. 

Needles. Sutures, silk of various sizes, 
and silkworm-gut. 

Needle-holder. Sims' speculum. Retrac- 
tors. Leg-holder. Sterilized stockings. 
Glass nozzles. Irrigation dressings. 

Tenacula are used to catch and hold movable tis- 
sues which are being sutured, to hold the cervix 
uteri, etc. There are two kinds, the curved and the 
straight; and of the curved there are three varieties: 
the shepherd's crook, the simple curved, and the cor- 
rugated. The shepherd's crook is much used in 
vaginal operations, and has the advantage over the 
others that when once it is put in place it can be 
dropped without losing its hold on the tissues. 

Instru7nents for Trachelorrhaphy. 



Catheter, glass. 


I 


Two-way catheter, 


I 


Curette, dull, 


I 


Curette, sharp. 


I 


Curette, spoon. 


I 


Dilators, different sizes. 




Forceps, hemostatic, 


8 pairs. 


Forceps, volsella. 


I pair. 


Forceps, bullet-. 


2, pairs. 


Forceps, long dressing- (Kelly), 


I pair. 


Forceps, tissue- (rat-tooth), 


2 pairs. 


Scalpels, 


■ 2 '' 


Speculum, Sims', small, 


I 


Speculum, large. 


I 


Shot-compressor and shot. 




Retractor, small. 


I 


Retractor, medium. 


I 



LIST OF INSTRUMENTS. 



I05 




Fig. 56. — Skene's reflux catheter. 




Fig. 57. — Volsella. 




Fig. 58. — Curved tenaculum. 




Fig. 59,— Kelly's leg holder. 



o6 



SURGICAL TECHNIC. 




Fig. 6o,— Snare. 



Fig. 6i, — Spoon curet. 



LIST OF INSTRUMENTS. 



107 




Fig. 62.— Curved scissors for performing trachelorrhaphy. 




Fig. 63. — Sir J. Y. Simpson's sound. 



Fig. 64. — Sharp curet. 



Fio. 65. — Dull wire curet. 




Fig. 66. — Gauze packer. 




Fig. 67. — Reiner's needle-holder. 



lo8 SURGICAL TECHNIC. 



Scissors, straight, 
Scissors, curved, 






I 

I 


pair. 

u 


Tenacula, 
Needles, curved. 


various sizes, 


short 


2 


pairs, 


stout, straight. 
Needle-holders, 






2, 




Uterine sound and applicator. 
Sterilized stockings. Leg-holder. 








Catgut and silkworm-gut sutures. 









Instruments for Dilatation of Cervix and Curetting 
of Uterus. 

Catheter, glass, small, i 

Catheter, two-way, for irrigation, i 

Curet, sharp, i 

Curet, Martin's double blunt, i 

Curet, curved, sharp, i 

Dilators (Hank's rubber, all sizes). 
Dilator, Goodell's, i 

Forceps, long dressing-, i pair. 

Forceps, bullet-, i '* 

Uterine sound and applicator. 
Sims' specula, large and small. 
Kelly perineal pad. Sterilized stockings. 

Irrigator. Glass nozzles. Dressings. 

Small sponges. Cotton pledgets. 
Churchill's tincture of iodin. 
Carbolic acid, 95 per cent. Leg-holder. 

Instruments for an Abdominal Operation, 
Arrange for Trendelenburg position. Secure this 
by special table ; elevation of one end of an ordi- 
nary table by means of blocks or upon two kitchen 
chairs or by placing a flat-backed chair upside down 



LIST OF INSTRUMENTS, 



109 




Fig. 69. — Schroeder's vaginal retractor. 




Fig. 70. — ^Varieties of hemostatic forceps. 



no SURGICAL TECH NIC. 

under the operating mattress ; secure the patient in 
position by tying with bandage, sheet, or towel. 

Forceps, small, hemostatic, 6 pairs. 

Forceps, medium, 6 " 

Forceps, pedicle-, 4 pairs. 

Forceps, long, 4 ** 

Forceps, long dressing-, i pain 

Forceps, for drainage-tube, i ** 

Forceps, Billroth, 2 pairs.. 

Forceps, bulldog, i pair. 

Forceps, rat-tooth, 2 pairs. 
Aspirator. Scalpels. Vaginal packer. 

Uterine sound. 
Paquelin's thermocautery. 

Sponge-holders. 6 
Scissors, long and small, i pair of each. 

Retractors, Lange's large, i pair. 

Volkmann's 6-prong retractors, i ** 

Volkmann's 4-prong retractors, i ** 
Long and small probe and director. 

Needle, aneurysm-, i 

Needle, transfixion, right curved, i 

Needle, transfixion, left curved, i 

Needle, transfixion, pedicle, i 
Needles, large, small, and intermediate, 

curved and intestinal. 
Murphy anastomosis button (sizes 1-4). 

Murphy's forceps for holding button, i pair. 

Murphy's forceps, intestinal clamp, i 

Murphy's forceps, introducing, i 
Flat dissector (Fenger). 
Drainage-tubes, glass or aluminum, as- 
sorted sizes. 

Needle-holders, 3 



u 



LIST OF INSTRUMENTS. 



Ill 





Fig. 71. — Murphy anastomosing FiG. 72. — Griffith's antiseptic irri- 
button : A, open ; B, closed. gator tip holder. 




Fig. 73. — Lange's retractor. 




Fig. 74. — ^Angiotribe of Tuffier. 



112 



SURGICAL TECHNIC. 




Fig. 75. — Bone-cutting forceps. 



I 







Fig. 77.— Eusta- Fig. 78.— Perios- Fig. 79.— Perios- 
chian catheter. teum knife. teal elevator. 



Fig. 76.— Cotton 
applicators for nose 
and ear work. 




Fig. 80. — Politzer's inflating bag. 



LIST OF INSTRUMENTS. 



113 




Fig. 84. — De Vilbiss bone-cutting forceps. 




Fig. 85. — Gigli's chain saw. 



114 SURGICAL TECHNIC. 

Dressings, ligatures, and sutures of silk- 
worm-gut, and various sizes of silk 
and catgut. 

Laparotomy sheet. Saline solution. 

Small bolsters, made of non-absorbent 
cotton covered with gauze, six 
inches by three, to retain the intes- 
tines and to keep them from encroach- 
ing upon the site of operation. 

Extra^ for Cysts or Tumors, 

Trocars, large and small. Rubber tubing. 
Nelaton's forceps. 

Billroth' s tumor- forceps, 2 pairs. 

Angiotribe or tumor-pedicle crushing for- 
ceps. 

Extra^ for Vaginal Hysterectomy, 
Sterilized stockings. lyCg-holder. 
Clamp-forceps, 6 pairs. 

Uterine sound. Dissecting forceps. Long 
and short tenacula. Speculum. Curet. 

Instruments for Operations on the Brain and Spine. 
Forceps, hemostatic, medium, 6 pairs. 

Forceps, hemostatic, small, 6 *' 

Forceps, rat- tooth (tissue-), 2 '' 

Forceps, bone, three kinds ; long-jaw forceps.. 
Trephine — three sizes, small and medium. 
Chisels, various sizes. Hammer. 
Scalpels, 2 

Scissors, 2 pairs. 

Curets, sharp and dull. 
Needles. Sutures. Ligatures. Saline 
solution. De Vilbiss forceps. 



LIST OF INSTRUMENTS. II5 




jTjQ 85. — Catlin, knife, and saws for amputation. 



Y\G. 89.— Modem combination of Baude- Fig. 90.— Nipple-shield, 

locque's and Osiander's pelvimeter. 



Il6 SURGICAL TECHNIC. 

Instruments for Amputation of a Limh. 

Esmarcli bandages, 2, 

Periosteotome, I 

Long ampntating-knife. 

Medium ampntating-knife. 

Scalpels, large and medium. 

Bone-saw. Chain-saw. 

Forceps, small hemostatic, 6 pairs. 

Forceps, medium hemostatic, 6 *' 

Forceps, bone-cutting, straight, curved, 
and angular. 

Forceps, gouging. 

Forceps, rat-tooth (tissue-), 7, pairs. 

Forceps, retractor, i pair. 

Scissors, large and small, i pair of each. 

Bone-pins. 

Four-prong retractors, 2 

Three-tailed gauze retractors, 2 

Dressings. Sutures. Ligatures of silk, 
catgut (various sizes), and silkworm- 
gut. 

Obstetrical Instruments and ApplianceSo 
Bed-pan. 

Fountain syringe. 
Glass catheter. 

Glass catheter, two-way, for irrigation. 
Scissors. 
Cranioclast. 
Perforator. 
Breast-pump. 
Nipple shield. 
Incubator, for premature-born children. 



LIST OF INSTRUMENTS. 



Instruments for the Mouth and Throat, 



Head-mirror. Snare of silver wire. 

Volsella forceps for tonsils. 

Uvulatome. Tonsillotome, 

Sponge-holders, 

Uvula scissors with and without claws. 

Tongue-depressor.^ 

A self-fastening mouth-gag. 

Trachea-dilator. 

Trachea-tubes. Intubation-tubes. 

Ivong forceps, 

Long curved forceps, 

Ivong straight scissors, 

Throat-mirror (laryngoscope). 

Angular forceps. 

Angular scissors, 

lyong, slender curet. 

Gottstein knife (for adenoids). 

Gradle forceps (for adenoids). 

Bistoury. Flexible probe. 

Esophageal sound and dilator. 

Fish-bone catcher for foreign bodies. 



I pair. 



I pair, 
it 



Instruments for the Nose, 

Polypus-snare. Silver applicator. 

Nasal curet. 

Saw with reversible blade for cutting up 
or down. 

Nasal scissors, with and without saw- 
teeth. 

Nasal bone-scissors. 

Nasal bone-scissors, turbinated. 



Il8 SURGICAL TECHNIC, 

Nasal polypus-forceps. 

Septum-straightening forceps, i pair. 

Nasal speculum. 
Septum-knife. 

Electrocautery for hypertrophied turbin- 
ates and for hemostasis. 
Chromic acid. Applicators, 
lodoform-s trips for packing. 
MonselPs solution for hemostasis. 

Instrumejits for the Eye^ 
Lens (double convex). 
Ophthalmoscope. 
Speculum. 
Cataract knife. 
Strabismus hook. 
Probes. 
Iris forceps. 
Fixation forceps. 
Keratome. 
Cystotome. 
Horn or metal spoon. 
Wire loop. 

Instruments for the Ear, 

For Mastoid Operations. 

Forceps, hemostatic, small, 8 pairs. 

Scalpels, small and medium, i each. 

Chisels and gouges, various sizes. 

Mastoid drills and bone- trephines, 2 

Mallet. 

Ear-speculums, various sizes. 

Diagnostic tube and otoscope. 

Ear-syringe (hard rubber). 



LIST OF INSTRUMENTS. 



119 




Fig. 91. — Septum com- FlG. 92.— Probang FiG. 94. — Ridal speculum, 
pression forceps. for removing foreign 
bodies from the 
throat. 



20 



SURGICAL TECHNIC. 




Fig, 96. — Curved sharp-pointed scissors. 




Fig. 97. — Eyelid speculum. 



Fig. 95, — Sharp- 
pointed re- 
tractor. 




Fig, q8. — Rawliide mallet. 




Fig. 99. — Tonsillotome. 



LIST OF INSTRUMENTS 



121 





Fig. ioo. — Tracheal tube. 



Fig. ioi. — Tracheotomy- 
forceps. 



I|fii!iiiiiiiii,, 




Fig. 102. — Powder-blower for nose and ear work. 



a 



Fig. 103. — Steel-eyed curet. 



122 SURGICAL TECH NIC. 




Fig. 104. — Adenoid forceps. 




Fig. 105. — Mouth-gag. 




Fig. 106. — Brenner's ureter-cystoscope. 




Fig. 107. — Phimosis forceps. 



LIST OF INSTRUMENTS. 



^^3> 



Fig. io8. — Cata- Fig. 109. — Cysto- Fig. no.— Cap- Fig. in. — Metal 
ract knife. tome. sule forceps. spoon. 



c> 



Fig. 112.- Wire loop for extraction of lens. 




Fig. ii3.--Loring's ophthalmoscope. 



124 



SURGICAL TECHNIC. 




Fig. 114. — Griffith's one-piece woodt 




Fig. 115.— Rectal speculum, 
large size. 



Fig. 116.— Rectal speculum, 
small size. 



Fig. 117.— Probes, 





f IG. 118.— De Vilbiss trephine. FiG. 119.— Gruber's ear specula. 



LIST OF INSTRUMENTS. \ 

Sponge- and cotton-holder. 

Small curet. 

Irrigator. 

For Middle-ear Operations. 

Eustachian catheter, and Politzer's air- 
bag. 
Curets. Ear-scoop. 
Snare and wire. 
Head-mirror. 
Cotton-holder. 
.Tympanum-perforators. 
Ear-aspirator for cleansing middle ear. 
Case of tuning-forks and hammer. 
Ear-scissors. 

Ear-speculum, various sizes. 
Slender polypus-forceps, i pair. 

Slender scalpels. 
Ear-probe. Irrigator. 

Instruments for Rectal Operations* 

Rectal speculum. 

Forceps, small hemostatic. 

Forceps, hemorrhoid. 

Scalpel.- Paquelin's cautery. 

Rectal bougies. 

Sterilized stockings. I^eg-holder. 

Kelly perineal pad. 

Irrigator. Dressings. Sutures. Liga- - 

tures. 
Curets, sharp and dull, i pair of each, 

Saw and chisels for Kraske's operation. 
Metal probes for tracing fistulse. 



25 



126 SURGICAL TECHNia 

Instruments for Urethral and Bladder Operations, 

Set of sounds, curved and straight. 

Catheters, various sizes. 

Urethral forceps, i pair. 

Artery-dilators, various sizes. 

Endoscopes with calibrators, various 
sizes. 

Urethral searcher. 

Head-mirror. Return-irrigator. 

Sounds and dilators (usually the same). 

Scalpels, artery-forceps, lithotrites. 

Stone-forceps, litholapaxy set. 

Curets, etc., for suprapubic or perineal 
lithotomy, or for litholapaxy, opera- 
tions on tumors, etc. 

Necessary for Dressings after Gynecologic 
Operations, 
Sims speculum. 

Bullet-forceps, i pair. 

Long dressing-forceps (Kelly). 
Applicator. Scissors, straight, i *' 

Churchill's tincture of iodin. 
Carbolic acid, 95 per cent. Ichthyol. 
Balsam of Peru and glycerin. 
Glycerin (pure). Vaselin. 
Tampons. Boric acid solution. 
Irrigator. Kelly perineal pad. 
Andrews stitch-cutter for the removal 

of silkworm-gut stitches from the 

vagina and cervix. 



LIST OF INSTRUMENTS. 



127 




Fig, 120.— Canton-flannel 
legging (Hirst). 



Fig. 121. — Griffith's director, 
eyed (to enter deep-seated pus 
collections by being passed down, 
the aspirating needle used as a 
guide). 



Fig. 122.— Keyes' stone-searcher. 



A-^ 




FIG.123.— Gouley's tunnelled catheter threaded on a filiform bougie. 



128 



SURGICAL TECHNIC. 




FIG.124.— Gant's pile clamp. 




Fig. 125.— Lithotrite. 




Fig, 126.— Bigelow's evacuator. 



LIST OF INSTRUMENTS. I2g 

For Cystoscopic Examination. 

Head-mirror. 

Urethral calibrator and dilator. 
Urethral searcher. 
Vesical specula with obturators. 
Bvacuator for removing urine. 
Long-mouthed toothed forceps. 
Applicator. 

Cocain solution, lo per cent. 
Boroglycerid to lubricate the speculum 
and dilator. 

In private practice a head-mirror or reflector can 
be improvised with a lamp or candle and a mirror. 



CHAPTER IX. 
ANESTHESIA. 

Anesthetics are divided into two classes, local 
and general. In local anesthesia the patient does 
not lose consciousness; but in general anesthesia 
consciousness is lost, the brain, together with 
the rest of the body, is narcotized, and there is pro- 
found sleep from which the patient awakens slowly. 
Both classes of anesthetics are used in surgery. 

We have practically four general anesthetics, one 
a gas, nitrous oxid, and three in liquid form : ether, 
chloroform, and ethyl bromid. The first is em- 
ployed in dentistry and as a preliminary anesthetic, 
while the last three are used in general surgical 
work. The administration of the anesthetic is a 
duty which may unavoidably fall to the nurse in 
emergency cases. 

The anesthetic should be administered in a room 
apart from the operating-room, so that the patient 
may be spared the sight of the preparations for the 
operation and the necessary display of instruments. 
Before giving the anesthetic the urine, heart, lungs, 
and mouth are examined, the mouth because patients 
are apt to deny the presence of false teeth, and male 
patients have been known to go to the anesthetizing 
room with tobacco in their mouths. The patient's 
habits should be known. Alcoholic patients pass 
through the exciting stage of anesthesia with con- 
130 



ANESTHESIA, 



131 




Fig. 127.— Portable apparatus for nitrous-oxid gas. 




Fig. 128. — Luer's hypodermic syringe. 




Fig. 129.— Hard-rubber FiG. 130.— Griffith's wooden mouth-wedge 

oral screw. and gag. 



132 SURGICAL TECHNIC. 

siderable struggling; they are also more liable to 
congestions. 

An anesthetic must never be given on a full stom- 
ach, because the patient may vomit, and particles of 
food may lodge in the larynx and trachea and result 
in strangulation. An interval of four to six hours 
should be allowed for, or in emergency the patient's 
stomach may require to be washed by use of stomach- 
tube and warm water siphonage. The bladder and 
bowels must always be emptied, or they may act in- 
voluntarily. False teeth must be removed, as there is 
danger of their being swallowed. 

Absolute silence must be maintained while the 
anesthetic is being administered, as anything said 
may be heard by the patient and be repeated. What- 
ever is said by the patient during the anesthetic state, 
or while going into or coming out of it, must be kept 
absolutely secret. Family secrets and other things 
may be told which might make great trouble if they 
were repeated. So a religious silence must be ob- 
served by every one with regard to any statement 
that the patient may make while intoxicated. Care 
must also be taken that the operation is not dis- 
cussed. Many patients have been made very un- 
happy through carelessness on this point; for they 
can often hear everything that is said by the doctors, 
students, and nurse, but are totally unable to make 
any sign by which a bystander may know that they 
can hear. These are about the first lessons that 
should be impressed upon a nurse when she be- 
gins her operating-room service. Oliver Wendell 
Holmes, in his Medical Essays^ says: ''It is a ter- 
rible thing to take away hope, even earthly hope, 
from a fellow-creature. Be very careful what name§ 



ANESTHESIA. 1 33 

you let fall before your patient. He knows what it 
means when you tell him he has tubercles, or Bright's 
disease; and if he hears the word carcinoma, he will 
certainly look it out in a medical dictionary, if he 
does not interpret its dread significance on the 
instant. ' ' 

It is not always best that the patient should know 
that she has carcinoma; if she hears that word, she 
will feel that it is a sentence of death sooner or later, 
and her life will be made miserable, whereas, if she 
is not informed as to the nature of her condition, her 
life can often be made more comfortable. 

The giving of the anesthetic is by no means a sub- 
ordinate duty. It requires a very skilled and trust- 
w^orthy assistant, one Avho is competent to act in case 
of emergency, because the life of the patient is as 
much in the hands of the anesthetist as in those 
of the operator. The anesthetist's whole attention 
must be given to the administration of the drug. 
Consequently, he cannot also watch the operator. 

The majority of patients are opposed to giving up 
consciousness, and often it costs a great struggle. It 
is here that a nurse should inspire her patient with 
confidence. Although we see many operations in 
the hospital in a single day, yet to the patient it is 
the one great event in his or her life. 

Some patients have an idea that an operation is 
mere butchery; while others Avho have any control 
over themselves can be shown the operating-room in 
readiness for work. A few cheering words convey- 
ing the right meaning are all that is needed, but we 
should remember that these are needed. 

In all operations in which an anesthetic is em- 



134 SURGICAL TECHNIC. 

ployed, even in those of a minor character, it is well 
to be prepared for accidents, such as heart-failure, 
arrest of respiration, or hemorrhage. There should 
be a hypodermic tray, with bottles containing solu- 
tions of strychnin sulphate, atropin sulphate, digit- 
alis, whiskey, nitroglycerin, morphin sulphate, and 
camphorated oil. Two hypodermic syringes in good 
order should be in readiness. An oxygen-inhaling 
apparatus is a valuable adjunct to an operating-room, 
and may prove useful in respiratory failure. It is 
also advisable to have a small faradic battery near 
at hand. A quantity of normal saline solution 
should always be in readiness for injection under 
the skin. 

The Allis inhaler is generally used, and in its 
absence a cone is to be preferred to a sponge, since a 
cone is always fresh and clean. An ether cone is 
made by folding a newspaper; or a straw cuff may be 
shaped to fit over the nose and mouth, a stiff towel 
being folded around and secured with safety-pins, and 
a clean handkerchief or piece of cotton placed inside. 
Ether should be given slowly; the cone should not 
be filled with ether and put over the face, entirely 
smothering the patient. The patient should be in- 
structed how to inhale it, slowly and deeply, and also 
to close the eyes, or cover them with a folded towel, 
because ether is an irritant to them. About two 
tablespoonfuls of ether are poured into the cone, 
which should be held a little distance from the 
patient's face, and as he becomes accustomed to the 
vapor and comes under its influence the cone may be 
brought nearer ; the strangling sensation, of which 
so many patients complain, is then in a measure 
avoided. A little patience exercised at the beginning 



ANESTHESIA. 



35 



obtains more satisfactory results and less shock than 
when the drug is crowded, and force is used to re- 




FiG. 131. — Allis's aseptic ether-inhaler. 

strain the struggles of the patient. Ether generally- 
first produces choking and coughing, followed by ex- 
citement ; that is fol- 
lowed by the muscles 
becoming rigid, the 
face may be cya- 
nosed, and the breath- 
ing stertorous or snor- 
ing ; this stage passes 
away, the muscles be- 
come relaxed, and the 
patient is in a state of 
insensibility. 

The lower jaw must 
be kept forward by placing the thumbs behind the 
angles of the jaw . Gentle pushing of the jaw for- 
ward and upward, which brings the upper behind the 




Fig. 132. — Method of pushing the lower 
jaw forward to prevent obstruction to 
breathing. 



136 SURGICAL TECHNIC. 

under teeth, keeps the tongue from slipping back and 
obstructing the larynx, and gives free access of air to 
the lungs. Should the tongue slip back, it may be 
pulled forward with the fingers or with a pair of for- 
ceps. Holding the tongue forward by means of pass- 
ing a suture through the tongue with a needle is rarely 
required ; neither should too much pressure be put 
on the tongue-forceps, for that will cause the tongue 
to become sore and swollen, and after the patient recov- 
ers from the anesthetic, about the first thing of which 
she complains is the soreness of tongue and jaws. Fre- 
quent inspirations of fresh air should be given. When 
completely etherized only a small quantity of the 
drug is needed to keep the patient under its influence. 
The eyeball should not be touched in order to ascer- 
tain if the patient is completely narcotized ; it is 
liable to cause conjunctivitis. Press down the upper 
eyelid on the eyeball ; if the patient makes no move- 
ment, and is perfectly relaxed, then insensibility is 
complete. Bronchorrhea (excessive mucus formation) 
usually occurs during the earlier stages of anesthesia ; 
but if proper care is taken not to crowd the ether at 
the start, the mucus secreted will not be of sufficient 
amount to cause any distressing symptom. When it 
does occur, the head should be turned to the side and 
the mouth wiped with a gauze sponge in a sponge- 
holder. Bronchorrhea may prove to be a distressing 
complication to the administration of .the anesthetic, 
inasmuch as the free secretion in the bronchi and 
bronchioles may interfere with thoroughly anesthet- 
izing the patient, and the patient is more prone to 
nausea from swallowing the mucus, which is probably 



ANESTHESIA. 1 3 7 

soaked with ether. If the patient seems inclined to 
vomit, the ether should be pushed, which will gener- 
ally ward it off; should she vomit, her head should be 
turned to one side, to allow the matter to escape more 
easily from the mouth. If the operation is about the 
neck or chest, the head must be turned to the opposite 
side, to prevent vomited matter from getting into the 




Fig. 133. — Griflfith's single-eared anesthetizing stethoscope, which will 
enable the anesthetist to have constant knowledge of the patient's heart and 
respiratory action while allowing the hands to be free. 

wound. Vomiting is usually due to incomplete anes- 
thesia and the admixture of too much air with the 
vapor. The anesthetic must be persistently given 
until the vomiting ceases and complete relaxation 
occurs. 

The mucus should be constantly wiped from the 
patient's mouth. The pupils should remain con- 
tracted all through etherization, and dilate when the 
patient is returning to consciousness. Dilated pupils 
mean one of two things: either that the patient is com- 
ing out of the anesthetic influence, or that she is too 
deeply anesthetized. We can readily ascertain which 
condition the patient is in by pouring a little ether 
into the cone. If she is coming out, she will cough, 
stop breathing, and give other signs of discomfort; 



138 SURGICAL TECHNIC. 

while if too deeply etherized she will breathe on 
steadily and not notice the fresh supply of ether; and 
the pupils will remain dilated until the muscles of 
the eyes regain their tone, when they contract. The 
sudden dilatation of the pupils is generally a sign of 
imminent death. It is very important for the anesthet- 
ist to watch carefully the respirations, because ether 
kills by suffocation, the heart usually beating long after 
the respirations have ceased. The anesthetist should 
speak out if the pulse is growing rapid, feeble, irreg- 
ular, or intermittent; if the respirations are becoming 
low, rapid, or gasping; if the face is becoming pale 
or blue; if the pupils are gradually dilating; or if 
the extremities are cold and there is profuse perspira- 
tion. In every case of continued doubt it is best to 
let the patient revive slightly. A very long anesthesia 
may lead to secondary prostration and collapse, and 
secondary shock from that cause alone. In other 
words, the prostration of the anesthetic is added to 
the effects of the operation. 

Primary anesthesia is that moment of temporary 
unconsciousness which comes on after the patient has 
taken a few inhalations, before the stage of excite- 
ment. 

In etherizing very young children it is best to put 
them on the back and at once to place the ether-cone 
over the mouth and nose without temporizing. If 
their pleadings to have the cone taken away are list- 
ened to (and they are hard to resist), their agony will 
only be prolonged and the operation delayed. Older 
children, once their confidence is won, may be grad- 
ually anesthetized as in the case of adults. Children 
are quickly etherized, and very rapidly recover from 
the influence of the ether. 



ANESTHESIA. 1 39 

Death from ether is slow, by paralysis of the respi- 
ration, the signs of danger being a blue and livid skin, 
and low, shallow, gasping respirations. It sometimes 
kills quickly by action upon the heart direct. Ether 
is very inflammable; hence the can should never be 
opened near a light or fire. 

Nausea and vomiting are very common after ether, 
but are usually over at the end of eighteen hours. 
The smell of the anesthetic, due to saturation of the 
patient's hair with the vapor, in a woman may be pre- 
vented by protecting the individual's head by means 
of a towel held in place by use of safety-pins before 
going into the operating room. Postoperative vomit- 
ing may sometimes be overcome by applying an ab- 
dominal binder wrung out in cold water — the so-called 
Neptune girdle. Should vomiting persist until the 
following day, it may be due to shock or to some 
cause other than ether. It may be relieved by the 
inhalation of hot, strong vinegar fumes ; a cloth wet 
with vinegar placed over the mouth and nose ; tea- 
spoonful doses of very hot water, either plain or with 
four grains of bicarbonate of sodium added to one 
ounce of water ; crushed ice ; champagne and ice ; 
small doses of brandy and ice ; black coffee ; aromatic 
spirits of ammonia, or sometimes tea. Cocain, one- 
fourth grain every two hours for five doses, has been 
successful in severe cases ; also a mustard-leaf applied 
over the stomach, and the washing out of the stomach. 
Oxygen gas is now frequently administered both to 
lessen nausea and to hasten consciousness. As a last 
resort, when all other treatment fails and there is 
danger that the severe retching will exhaust the 
patient, morphin, one-sixth grain, is injected over 
the epigastrium. 



140 



SURGICAL TECHNIC. 



Chloroform is similar in its action to ether, and is 
often to be preferred to it, because it is pleasanter to 




Fig. 134. — Griffith's wire-frame 
chloroform inhaler. 




Fig. 135. — Griffith's chloroform in- 
haler covered with square of double- 
thickness gauze. 



take, rapidly recovered from, does not produce excite- 
ment or subsequent vomiting, and the patient is 





'4 ^^^j^pmiBM»' 






.1 



Fig. 136. — Mask and tube for ethyl chlorid (Hirst). 

brought more quickly under its influence. It is, 
however, more depressing to the heart than ether, 



ANES THE SI A. 1 4 1 

and therefore more dangerous. The patient is not 
allowed to rise until all effects have passed off. To 
give chloroform, a few drops m.ay be sprinkled on 
an Bsmarch inhaler, a handkerchief, a towel, or a 
small wire framework covered with gauze. Where 
the operation is on the mouth, so that all available 
space and light is demanded, after the patient is fully 
anesthetized it is administered on a small gauze sponge 
clamped in forceps which are held several inches 
above the mouth. Vaselin should first be spread over 
the face, and especially around the lips and nose, to 
prevent the burning which might occur should any 
of the fluid drop. Acrid vomit sometimes causes 
superficial skin burns* Preventive treatment consists 
in cleansing with a wetted towel or one wrung out in 
weak soda solution. The same symptoms are to be 
watched for as in the case of ether. Death from 
chloroform is almost always sudden, from paralysis 
of the heart ; the pupils become dilated, the face pale, 
and the pulse flickering. These symptoms usually 
come on with little or no warning. 

Ethyl bromid is often used as a substitute for chloro- 
form, which it resembles in its action, except that it 
is more prompt. It is employed in minor operations 
and gynecologic examinations. About half a dram 
is poured on a folded towel, or chloroform-inhaler, 
and held close to the mouth and nose. The same 
amount is added at intervals until the patient is com- 
pletely narcotized. The stage of excitement is short, 
and its elimination is rapid. It leaves a disagreeable 
odor of garlic on the breath, which may last several 
days; but, on the other hand, the patient recovers 
rapidly, and may be able in a very little while to 
resume work. 



142 SURGICAL TECHNIC. 

Ethyl bromid is also used as a local anesthetic in 
the form of a spray. 

SchleicK' s anesthetic consists of one and a half 
ounces of chloroform, one-half ounce of petroleum 
ether, and six ounces of ordinary ether. It is given 
in an Esmarch inhaler, and is considered to be safer 
than chloroform. Unconsciousness is obtained usu- 
ally in one minute and a half; there is no excite- 
ment, and the reaction is rapid. There are three 
forms of this solution, the other two being weaker. 

Local anesthetics are those which abolish the 
sensibility of the peripheral nerves of a particular 
area (Brunton). 

Cocain is the best one that we have at present; the 
others are ethyl chlorid, eucain, menthol-chloral, 
orthoform, freezing with ice and salt, carbolic acid, 
alcohol, ether, the so-called infiltration-anesthesia. 

Ice. — The disadvantage of using ice is that it is 
always followed by a reaction, the blood-vessels 
becoming filled with blood; and the patient suffers 
the pain and tingling sensation which follow intense 
cold. It is used in the following way : To a little, 
finely-chopped ice is added about a quarter the 
amount of salt; this mixture is placed in a piece of 
gauze and laid over the part, which in about ten 
minutes becomes white and numb. 

Eucain is much used as a local anesthetic in sur- 
gery of the nose, throat, and ear in strengths of 2, 
5, and 8 per cent. In the onset its action is slightly 
slower than that of cocain, from five to ten minutes 
elapsing before the patient is ready for operation, 
but when established the anesthesia is fully equal to 
that of cocain. The duration of the anesthesia is 



ANESTHESIA. I43 

from ten to twenty minutes, fifteen minutes being 
the most usual time. 

Cocain hydrochlorate is a very good anesthetic. It 
is ordinarily employed in a -^-^ of i per cent, to a 4 per 
cent, solution, and is principally applied to the mu- 
cous membranes, such as the eye, the mouth, the nose, 
the urethra. It is not so effective when applied 
to the sound skin ; in order to produce anesthesia 
there it must be injected subcutaneously, when it 
gives rise to a rapid edema of the tissues. It has the 
power of shrinking up the blood-vessels and tempo- 
rarily driving the blood out of the parts, which is 
quite an advantage in minor operations. 

One-half grain of cocain hydrochlorate dissolved 
in an ounce of water forms a yo per cent, solution : 
eighteen grains of cocain hydrochlorate to one 
ounce of water is a 4 per cent, solution. One grain 
of boric acid added to the solution will prevent the 
development of fungi, and the solution remains 
aseptic. The solution should be kept in a cool spot, 
for if placed in a temperature higher than 60° F. it 
begins to lose its anesthetic properties. 

The use of the cocain discoids enables the nurse to 
prepare a desired amount of a fresh solution at a mo- 
ment's notice. They are convenient and safe, and 
contain accurately weighed quantities of pure cocain. 

The phe7iate of cocahi is a local anesthetic, used in 
from 5 to 10 per cent, solutions. It takes longer to 
act than the hydrochlorate; it also coagulates the 
tissues and lessens absorption. 

Ethyl chlorid is a local anesthetic, acting by freez- 
ing the parts. It is put up in glass tubes. The cap 
is removed from the tip of the tube and the bulb held 



144 SURGICAL TECHNIC. 

in the palm of the hand, the warmth of which causes 
the liquid to escape in a vaporized stream. The tube 
is held a little distance from the part to be operated 
upon, y/hich whitens and is ready for operation in 
about fifteen seconds. 

The method of injiltration-anesthesta (local anes- 
thesia b}^ injection of solutions in the skin) was in- 
troduced by Schleich, who claims that a weak solu- 
tion of cocain hydrochlorate, with common salt, and 
a small amount of morphin, will produce a thorough 
and prolonged anesthesia. There are three prepara- 
tions, each of which is put up in tablet-form, contain- 
ing the proper proportions : 



No. I. Strong, — 




Cocain. hydrochlor., 


Igr. 


Morph. hydrochlor., 


igr. 


Sodium chlorid, 


igr. 


No. 2. Normal, — 




Cocain. hydrochlor., 


igr. 


Morph. hydrochlor., 


igr. 


Sodium chlorid, 


Igr. 


No. 3o Weak. — 




Cocain. hydrochlor.. 


2V gr. 


Morph. hydrochlor., 


igr. 


Sodium chlorid, 


Igr. 



The tablets should be dissolved in distilled sterilized 
water. 

Alcohol and ether are local anesthetics, as is also 
any agent which evaporates rapidly and produces 
cold. 

Cocain anesthesia has become an important factor 



ANESTHESIA. 



145 



in modern surgical procedures. While generally con- 
fined to use in so-called minor operations, such as the 
laying open of abscesses and finger amputations, some 
surgeons have not hesitated to employ it success- 
fully in operations for appendicitis, hernia, and gland- 
ular tumors of the neck. It has been determined 
that a To per cent, solution of the hydrochlorate of 
cocain will anesthetize the skin for a period of from 
forty-five minutes to one hour and a half. 




Fig. 137. — Griffith's combined inhaler for gas and liquid anesthetics. 



Spinal cocainization produced by injecting a solu- 
tion of hydrochlorate of cocain (mixed up with spinal 
fluid to form i to 4 per cent.) directly into the spinal 
canal has been employed. This procedure must be 
carried out with absolutely sterile implements. From 
its manifest dangers it is now believed to have a very 
limited usefulness. 

Cocain poisoning may be avoided by never employ- 
10 



146 SURGICAL TECHNIC. 

ing more than the amount of sohition equalling one- 
third of a grain of cocain hydrochlorate. The symp- 
toms of overdose are dryness of the mouth and throat, 
mental excitement, delirium, dilated pupils, with 
increased heart and respiratory action, convulsions. 
Treatment of oncoming symptoms consists in hypo- 
dermic injections of full doses of morphin sulphate. 
General anesthesia is now secured with greater de- 
spatch and'with more comfort to the patient by means 
of the mixed gases of oxygen and nitrous oxid, the 
ill effects of the latter gas, whose action is that of 
mechanical suffocation, being overcome by the oxygen, 
or by the employment of nitrous oxid gas alone as a 
preliminary to ether. Owing to the more active 
properties of chloroform it is not generally employed 
in the combination anesthesia. 



CHAPTER X. 

ANTISEPTIC GAUZES, TAMPONS, THERMOCAU- 
TERY, SALINE INFUSIONS, IRRIGATION, ETC. 

Surgical Dressings. — Gauze and absorbent cot- 
ton are now almost universally used as wound-dress- 
ings. A dressing may be aseptic or antiseptic. An 
antiseptic dressing absorbs from the wound all dis- 
charges, prevents the access of germs to the wound 
from the outside, and also destroys all germs that may 
come in contact with it. An aseptic dressing has the 
same properties, with the exception that it cannot 
destroy germs. 

In selecting gauze for dressings, that which pos- 
sesses the greatest absorbent power should be secured. 
It should be soft, pliable^ and free from irritating and 
gritty materials. 

When applied to a wound, it should be unfolded 
and laid on loosely (fluffed) ; it thus forms a softer 
dressing and more readily absorbs the discharges. 

Absorbent cotton is ordinary cotton deprived of its 
oil, in order to render it absorbent. I^aid over gauze, 
it acts as a sieve through which germs cannot pass ; 
also as a spring}^ protective, by means of which the 
wound is protected from undue pressure. 

Antiseptic dressings are made by impregnating gauze 

147 



148 SURGICAL TECHNia 

with an antiseptic, such as bichlorid of mercury, 
iodoform. 

To make bichlorid gauze ^ the gauze after the initial 
boiling is immersed in a i : looo bichlorid solution for 
twenty-four hours, after which it is dried, cut into 
dressings, and packed in glass sterilized jars. 

Iodoform gauze may be made after the following 
formula : 



Cheese-cloth, 


5 yards. 


Alcohol, 


8 ounces, 


Iodoform, 


3 " 


Ether, 


7 " 


Glycerin, 


3 " 



Shake the alcohol and iodoform together in a sterile 
bottle for fifteen minutes, then add the glycerin, and 
lastly the ether. Put all into a sterilized stone jar ; 
then rub the mixture into the gauze thoroughly, and 
cut the latter into strips two inches wide. Each strip 
is rolled up separately, and several strips are placed 
in a sterilized jar. When required for use a strip is 
taken out with sterile forceps. 

In some cases an emulsion of iodoform is rubbed 
into the gauze. This emulsion, according to Wharton, 
is made by adding three drams of iodoform to six 
ounces of Castile soap-suds. This suffices to impreg- 
nate eighteen ounces of moist gauze. 

The iodoform glycerin or oil which is used for 
injections into wounds is prepared by taking 

Iodoform, 5 grams (75 grains). 

Glycerin, 100 c.c. (3!- ounces). 

Mix and place in a wide-mouthed flask of thin 



II 


drams. 


7 


u 


^% 


ounces. 



SURGICAL DRESSINGS, 1 49 

glass, and sterilize for one hour, plugging the flask 
afterward with sterilized cotton. 

Potasshmi-per77ianganate Gauze, — The formula for 
this is as follows : 

Potassium permanganate, 160 grains. 
Hot water (distilled), 33 ounces. 

The gauze is cut and rolled as for iodoform gauze, 
and saturated thoroughly in the above solution. It 
should be preserved in colored glass jars. 

Bismuth gauze is made after the subjoined 
formula : 

Bismuth subiodid, 
Glycerin, 
Water (distilled). 

Mix and rub thoroughly into the meshes of gauze, 
cut, and preserve the same as iodoform gauze. 

In emergency cases old sheets and clean linen may 
be cut to the desired size and sterilized in an oven. 

Collodion Dressing. — Collodion is a preparation of 
pyroxylin in alcohol and ether. On evaporation of 
the alcohol and ether a thin, impervious film of col- 
lodion is left. The collodion is either painted over 
the surface of the wound by means of a clean stick of 
wood or an applicator with sterile cotton fixed to the 
end, or thin layers of absorbent cotton are saturated 
with it, laid on the wound, and allowed to dry. Col- 
lodion is used only when the wound is aseptic. Vari- 
ous antiseptic agents, such as iodoform, boric acid, 
etc., maybe dissolved or suspended in the collodion. 
The surface of the wound must be perfectly dry, or 
the collodion will not adhere. An ordinary dry 



150 SURGICAL TECH NIC. 

dressing may be applied over the collodion as a further 
protective. 

Horsley'^ s wax is made of seven parts of beeswax 
to one part each of almond oil and salicylic acid. 

Rubber adhesive plaster is at times used in the later 
stages of wound-healing, for the purpose of drawing 
the edges together. The chief objection to its use is 
that it cannot be thoroughly sterilized. A protective 
dressing may be applied over it in the usual way. 
Rubber plaster is also used to take the place of band- 
ages where these are inconvenient or difficult of 
application. 




Fig. 138.— Vaginal tampon, sterilized and placed in a gelatin capsule ready 
for use (Hirst). 

Oiled silk or rubber protective is used when it is 
desirable to prevent sticking of the dressings to the 
wound, as in ulcers, and skin-grafting. The mate- 
rial is applied in narrow strips which ■ overlap each 
other like shingles. The strips are sterilized by wash- 
ing in cold soap-suds and soaking them in a i : 250 
solution of corrosive sublimate. They are then rinsed 
in sterile water or saline solution, in which they are 
allowed to float until needed by the surgeon. 



ANTISEPTIC POWDERS. 151 

Tents are small strips of rolled gauze used to 
keep a wound open for the escape of pus. They 
are rarely employed at present, having been replaced 
by the drainage-tube. The term tent more fre- 
quently designates a conical or cylindrical pencil of 
sponge, sea-tangle, and other substance, employed for 
dilating a narrow channel, such, for instance, as the 
cervical canal. When introduced, the tent expands 
from the absorption of moisture, and this dilates the 
part. 

Tampons are made of absorbent cotton, lambs' 
wool, or gauze, and are about seven inches long, one 
and one-half inches wide, and one-half an inch thick. 
They are folded and tied in the middle with a strong 
white thread or fine twine, leaving long ends by 
which to remove the tampon. The so-called kite-tail 
tampon is made by fastening several of these pieces 
of cotton to a thread about two inches apart. The 
tampons may after sterilization be kept in a dry, 
sterile jar, or they may be thoroughly soaked in water 
and then kept in glycerin. Tampons are principally 
used for introduction into the vagina. Previous to 
introduction they may be dipped into various special 
solutions. They are generally removed from the 
vagina on the day after the application. 

Antiseptic Powders. — Reference has already 
been made to these. Those most frequently em- 
ployed are iodoform, boric acid, acetanilid, dermatol, 
and mixtures of these various kinds. Iodoform and 
boric acid are generally combined in the proportion 
of one of the former to seven of the latter. The 
powders are kept in sterilized glass salt-cellars with 
silver-tops, which are covered with gauze when not 



152 



SURGICAL TECH NIC. 



in use, or in sterile wide-mouth bottles over which a 
piece of gauze is stretched. As the bottle may not 
be thoroughly clean on the outside, it should be 
handed to the surgeon wrapped in a sterile towel up 
to the top. 

The thermocautery, known also as the Paquelin 
cautery, because of its invention by Paquelin, of 
Paris, is frequently employed in surgery to control 



p^ 




Fig. 139.— Paquelin's thermocautery : Connect point or tip {d, d) to the 
container at {e) after pouring a teaspoonful of benzine into the reservoir {a). 
Connect bulbs to the bottom of the reservoir at (/). Attach the blowpipe {c). 
Open stopcocks {e and /), press the bulb and apply a lighted match at b. 
Remove blowpipe [c) and continue incandescence after platinum has begun 
to glow by gently working the bulb. 

bleeding, and also to produce counter-irritation. 
The efficacy of this instrument depends on the fact 
that when the vapor of some highly combustible car- 
bon compound is driven over heated platinum its 
rapid incandescence is sufficient to maintain the heat 
of the metal. Platinum points of various shapes and 
sizes are attached to a rubber tube, which is con- 
nected with a metal container half full of benzine 
or alcohol, the vapor of which is pumped through 



NORMAL SALINE SOLUTION. 1 53 

the tubing and holder into the platinum point. In 
order to prepare the instrument for use benzin 
(above 65° Baume) is the best combustible, but wood- 
alcohol, naphtha, benzol, gasolene, ammonia-water, 
or ether may be used. 




Fig. 140. — Intravenous saline infusion. Manner of incising vein and 
inserting glass tube (Senn). 

After using, the container should be completely 
closed, and the points while hot must be removed 
from the handle and laid away to cool; they must 
not be put into water, but wiped perfectly clean. 
The handle when cool must be removed from the 
tubing, and each part must be carefully laid in its 
own compartment in the case. 

Normal saline solution is made to correspond as 
nearly as possible in specific gravity with the normal 
serum of the blood. The formula suggested by Dr. 



154 



SURGICAL TECH NIC. 



Locke of Boston and Dr. H. A. Hare, containing 
in one quart calcium chlorid 0.25 gm., potassium 
chlorid o.i g:m., sodium chlorid 9 gm., is usually 

employed. It not only 
gives the heart a better 
fluid to work upon, but it 
restores to the blood that 
coagulable quality which 
is diminished or lost by 
hemorrhage. Tablets con- 
taining this formula have 
been devised, and are 
usually used. One tablet 
added to one quart of water 
gives the correct strength. 
In absence of the tablets 
one teaspoonful of table 
salt is added to one pint 
of water. It is absolutely 
necessary whatever for- 
mula is used that the solu- 
tion and all the apparatus 
used be properly sterilized. 
If the water contains par- 
ticles that cannot be strain- 
ed out and there is no filter 
at hand, the water should 
stand until the sediment 
settles, when the fluid can 
be poured off, resterilized, and used. This solution is 
placed in an irrigator or a fountain-syringe which has 
been thoroughly sterilized with hot water and corro- 
sive-sublimate solution, and subsequently rinsed with 




Fig. 141. 



-Apparatus for hypodermo- 
clysis (Hirst). 



NORMAL SALINE SOLUTION 



155 



boiled water. A long hypodermic needle, which has 
also been thoroughly sterilized, is fastened to the end 
of the rubber tube connected with the irrigator or 
fountain-syringe. The fluid may be kept in a pitcher 
and poured into a glass funnel to which the rubber 
tube is attached. The temperature of the solution 
should be about 100° F. The solution is intro- 
duced under the skin of either the chest, the abdo- 




FlG. 142. — Apparatus for douching the abdominal cavity (Hirst). 



men, the thigh, the arm, or between the shoulder- 
blades. From a pint to two quarts are injected at 
one time. The part selected for the injection is to 
be sterilized thoroughly in advance. Saline infusion 
is also given by the rectum, a long rectal tube being 
used. 

In hospitals it is customary to keep on hand flasks 
of saline solution. These flasks are sterilized before 



156 



SURGICAL TECHNIC. 



filling ; afterward they are stopped with sterile cot- 
ton-plugs and sterilized again by boiling for one 
hour on three successive days. 

Normal salt solution is used for 
irrigation and for injections in cases 
of shock, in acute diabetic and 
uremic coma, hemorrhage, puer- 
peral infection and eclampsia. 

Irrigation. — Irrigation, or flush- 
ing, is employed to cleanse wounds 
and wash out cavities, such as the 
uterus, the abdomen. The solu- 
tions employed are various. Many 
surgeons use sterile salt-solution or 
plain boiled water. Antiseptic solu- 
tions, such as bichlorid solution 
(i : 10,000 to I : 1000), boric acid 
solution, are used especially for 
septic wounds and surfaces. For 
purposes of irrigation a conical glass 
vessel, with a tube at the bottom to 
which a rubber tube is attached, is 
commonly employed ; a fountain- 
syringe will also answer the purpose. 
The irrigating-nozzle is usually of 
glass. The solution should be warm ; 
when it is desired to check hemorrhage, it is used 
quite hot (110^-120° F.). 



Fig. 143. — Improvised 
apparatus for the irri- 
gation of a wound 
(DaCosta). 



CHAPTER XI. 

SUTURES AND LIGATURES; SPONGES; DRAIN- 
AGE; DRAINAGE=TUBES ; GAUZE DRAINS; 
RUBBER DAM; RUBBER AND COTTON 
GLOVES. 



Sutures, which are used to 
bring together the edges of a 
wound, may be of silver wire, 
silkworm-gut, twisted Chinese 
silk, kangaroo-tendon, catgut, 
and horse-hair. Of these, silk- 
worm-gut, catgut, and silk are 
most commonly ifsed. 

Catgut is made from the in- 
testine of the sheep. It is largely 
used for suture-material within 
the abdominal cavity or deeper 
layers of tissues, because it is 
absorbed by the fluids of the 
body, and does not remain after 
the healing of the external 
wound to constitute a foreign 
body. 

Kangaroo-tendon is prepared 
from the split sinews of the tail , J'""- ^^44.-siik in glass 

^ tube, on glass reels; the tube IS 

of that animal, and was intro- stopperedwith cotton (Hirst). 

157 



158 SURGICAL TECHNIC. 

duced by Dr. H. O. Marcy of Boston. It is obtainable 
in any size, and comes in pieces of about twenty inches 
in length. Its advantage over catgut consists in its 
greater strength. It is more easily sterilized, and 
does not lose its strength during perfect sterilization. 
It is particularly of value in buried sutures and liga- 
tures and continuous sutures at the surface. 

To prepare the kangaroo-tendon the following 
method may be used: The tendon having been 
soaked in absolute ether for forty-eight hours, is 
heated to a temperature of 100° C. in alcohol under 
pressure in a closed receptacle for one hour. This 
temperature is maintained by means of a water-bath. 
It is then put in mercuric chlorid solution, consisting 
of mercuric chlorid 40 grains, tartaric acid 200 grains, 
and alcohol 12 ounces, for ten minutes. It is then 
placed with sterilized forceps in sterilized glass-stop- 
pered jars containing bichlorid of palladium -^-^ grain 
to I pint of absolute alcohol. 

Silkworrn-giit is prepared for use by soaking for 
forty-eight hours in ether and one hour in i : 1000 
corrosive sublimate; it is then kept in a long tube of 
alcohol, though many surgeons prefer it made asep- 
tic by boiling two hours before the operation. It is 
seldom used as a buried suture, but chiefly in closing 
wounds with interrupted sutures. 

Catgut. — There are various methods of sterilizing 
catgut, among them the methods of Leavens and Fow- 
ler, by which catgut is kept in alcohol in sealed tubes, 
the preparation by formalin recently proposed by Senn, 
cumol catgut, all equally effective if judiciously car- 
ried out. The gut used should be of the very best 
quality. The following are the most popular methods 
of preparation : 



SUTURES AND LIGATURES. 



159 



I. Six strands of catgut, each fourteen inches long, 
are wound on glass reels and soaked in ether for twenty- 
four hours to remove all fatty substances. The spools 
are then removed with sterilized forceps and dropped 
into covered glass jars, containing 95 per cent, 
alcohol, care being taken that the catgut is com- 
pletely submerged and that allowance is made for 
evaporation. The mouth of the jar is covered with 




Fig. 145. — Sterile catgut in glass tubes ready for use. 

absorbent cotton and the jar placed on a water-bath, 
the water of which is gradually heated until the 
alcohol boils, when the jar is removed. This opera- 
tion is repeated on two successive days. On the third 
day of sterilization the absorbent cotton is removed, 
and a glass cover, fitted with a rubber protective to 
prevent evaporation, is screwed on. 

2. The catgut is soaked for twelve hours in a corro- 
sive sublimate solution (i : 1000), and afterward from 
twenty-four to forty-eight hours in oil of juniper. 
The spools are then transferred to covered glass jars, 
containing sufficient absolute alcohol to cover the cat- 
gut completely. The alcohol is changed every two 
weeks. 



l6o SURGICAL TECHNia 

3. Strands of catgut are soaked for twenty-four 
hours in oil of juniper, after which they are wound 
upon glass reels, and placed in covered glass jars con- 
taining absolute alcohol. 

Iodised Catgut. — Ordinary catgut placed for eight 
days in the following solution : 



lodin, 
Potassium iodin, 


I part. 
I " 


Water, 


100 parts. 



Tensile strength not affected up to six months. 

When used externally irritation to the skin may 
result (due to the action of iodin). 

Bichlorid Catgut (said to keep indefinitely). — Place 
the gut strings in ether for twenty-four hours (dis- 
solves out fat), then in a solution of: 

Bichlorid of mercury, i part. 

Alcohol (95 per cent.), 500 parts. 

Ordinary sized gut strings are sterile after eight 
days ; large sizes, after fourteen days. 

The method used by Dr. F. W. Johnson, of Bos- 
ton, Mass., is as follows: The gut is soaked in ether 
for several days. It is then cut into the desired 
length, each length being thoroughly stretched (the 
stretching prevents kinking and twisting). The gut 
is then soaked for twenty-four hours in absolute 
alcohol, to take out as much of the water as possible. 
It is then covered with a solution of bichromate of 
potassium in absolute alcohol (fifteen grains to the 
pint), and remains in this twelve hours. Each 
length is coiled up, wrapped in waxed paper, and put 
in an envelope, which is sealed. The sealed envel- 



SUTURES AND LIGATURES. l6l 

Opes are put in a dry oven, and baked for one hour 
at a temperature of ioo° C. This removes all moist- 
ure. On the following day the sealed envelopes are 
baked three hours at a temperature of 140° G. The 
gut is now ready for use. The envelopes are kept in 
a glass jar. An assistant tears open one end of an 
envelope, undoes the wax paper without touching 
the catgut, and hands it to the operator. In this way 
the gut is touched by no one, and touches nothing 
until picked up by the fingers of the operator. 

Formalin Preparation. — Formalin is also used in 
the preparation of catgut. The catgut is wound 
on a glass spool, not too tightly, and soaked for 
two days in equal parts of ether and alcohol, after 
which it is rinsed in pure alcohol for a few moments 
and transferred to glass bottles with tightly fitting 
covers, and which have been previously sterilized, 
containing equal parts of formalin and alcohol, 
more than enough to cover the catgut. After one 
week the catgut is taken out and boiled for half 
an hour in normal saline solution, and is then 
placed in sterilized bottles containing alcohol until 
needed. 

Silk is sterilized by being boiled for two hours 
before the operation. Five yards each of various 
sizes of twisted Chinese and pedicle silk are wound 
on glass spools and allowed to boil for two hours 
before the operation. When called for by the oper- 
ator the pan containing the silk is handed to him, 
and he takes out the required size with sterilized 
forceps. In this w^ay the sutures and ligatures are 
touched by no one but the surgeon himself. It is 

always a good plan to sterilize fresh silk for each 
11 



l62 SURGICAL TECHNIC. 

major operation. By so doing we are sure of it being 
perfectly aseptic. 

To sterilize horsehair, first wash thoroughly in 
green soapsuds ; rinse several times ; soak in ether 
for twenty- four hours. Boil in sterile water for 
twenty minutes. Preserve in alcohol, 95 per cent. 

Silver wire is sterilized by means of dry heat or by 
boiling in a I per cent, soda solution with the instru- 
ments. Usually the latter is preferred. 

The interrupted sttture is made by passing catgut 
or silk through the skin from one side of the wound 






^,«w#^ "M-^i i-'W' - \fr'''''!^A"^^.'0"'''^-. '^i, 






Fig. 146.— Interrupted suture FiG. I47-— Continued or Glover's 

(Bernard and Huette). suture (Bernard and Huette). 

to the other ; then both ends are drawn together and 
tied in a double knot. The continuous suture is the 
ordinary over-and-over stitch from one end of the 
wound to the other. The button suture is made by 
passing wire across the bottom of the wound, bring- 
ing out the ends about one inch from the edge of the 





Fig. 148. — Button suture (Bryant). FiG. 149. — Metal suturing clamps. 

wound, and securing each end with a button. The 
shotted suture is one in which the ends of the suture, 



SPONGES. 163 

after it is introduced, are passed through a perforated 
shot, which is then clamped. 

Metal Siituring Clamps. — Modified serrefines, 
made of block tin, they have been successfully em- 
ployed as sutures, being readily applied or detached 
by dissecting forceps. Infection through the skin or 
stitch-hole abscess does not occur from their use, as 
the retaining spur does not deeply puncture. Scar- 
ring is decreased by their employment, and claims for 
value in intestine sewing have been made. 

Stitch abscesses are usually produced by unclean 
suture-material. They may be caused by tying the 
stitches too tightly; but, as a rule, they occur when 
the sutures are not carefully sterilized. This is the 
reason why so many operators prefer their silk and 
silkworm-gut boiled immediately before using. It 
cannot be denied that a sterile suture may become in- 
fected when passing through the deeper layers of the 
epidermis, and so give rise to a stitch-hole abscess. 

Sponges. — Sponges are used to wash wound-sur- 
faces and to absorb or soak up fluids. The sponges 
most commonly employed are in the form of the 
gauze pads, the cut edges being folded over and 
loosely hemmed, and of square pieces of gauze, each 
piece being rolled loosely in the form of a ball, the 
free end being twisted and tucked in. The marine 
sponges are not often used at the present time. Gauze 
sponges are never employed more than once. Those 
used in operations are afterward destroyed; those not 
used are resterilized, placed in sterilized towels, and 
deposited in covered glass jars, which are not uncov- 
ered until called for at an operation. 

The great advantage of gauze over a marine sponge 
is that it can be thoroughly sterilized. 



164 SURGICAL TECHNIC. 

If marine sponges are required for an operation, the 
dark-colored ones should be bought. They do not look 
so attractive, but they are the finest sponges; they are 
"uncut" and "unbleached," and give more service 
than the clearer-looking ones, which are partly or 
wholly bleached. The bleached and cheaper sponges 
have been made by cutting one large sponge into 
several small ones; or by cutting off portions that 
were torn in taking the sponges from the ocean. 

Marine sponges should be prepared as follows-: i. 
lyay them in a stout cloth and pound sufficiently to 
break up grit and lime. 2. Rinse with warm water 
until it remains clear. 3. Immerse in hydrochloric 
acid solution (two drams to one quart of water) for 
twenty-four hours. 4. Immerse in saturated solution of 
permanganate of potassium, followed with oxalic acid, 
then pass them through lime-water to take out all 
the oxalic acid, and rinse well in plain sterile water; 
after which they are immersed for twenty-four hours 
in a 1 : 1000 corrosive sublimate solution. They are 
preserved until used in a 3 per cent, carbolic acid 
solution. 

When wanted for use the sponges are lifted out of 
the jar with long dressing-forceps and rinsed in plain 
sterile water. 

Gau^e pads for abdominal operations are made of 
eight thicknesses of gauze about eight inches square, 
with the edges tucked in and hemmed to prevent 
fraying. 

Pads are usually made in sets of five, seven, or nine 
for purposes of identification. As a further precau- 
tion to prevent a pad being left within the abdominal 
cavity the first pad should have a stout threaded cord 



NEEDLES. 165 

attached to it. Additional pads may now be threaded 
upon the cord, all being removed without fear from 
miscount. K weighted or gravity pad made by quilt- 
ing flat bits of lead within the layers of gauze may 
be useful at times to act as a retractor of the intes- 
tines. 

Gau^e, now considered the most valuable of 
dressings for wounds, is cut into sections of four 
thicknesses and folded into dressings. A large num- 
ber of these are sterilized for two hours, when they 
are removed with perfectly aseptic hands and placed 
in sterilized jars. 

Absorbent cotton used in dressing cases is pre- 
pared in the same way. 

Some hospitals find it expedient to sort, wash, re- 
sterilize, and use over soiled bandages and gauze. 
Cotton waste, after being boiled, sterilized, and dried, 
is used in place of absorbent cotton and gauze for the 
filling of pads. 

To sterilize oils or glycerin, place in a water-bath 
and boil for two hours. 

Needles of various shapes and sizes required for 
an operation are sterilized with the instruments. 
Many operators prefer the needles to be threaded, 
then attached to a towel, which is folded, enveloped 
in another towel, and securely fastened. These bun- 
dles are sterilized and are not opened until called 
for by the operator or his assistants. After the opera- 
tion is completed the sutures and ligaments which 
have not been used are carefully dried and resterilized. 
In choosing the needles care must be taken that only 
sharp needles and strong sutures and ligatures are 
selected for use. 



l66 SURGICAL TECHNIC. 

Sheets, gowns, and towels used in operations are all 
made into convenient bundles and sterilized for two 
hours prior to an operation. Bundles once opened 
are not used again for other operations until they are 
resterilized. 

l^tnergency bundles containing everything neces- 
sary for an emergency operation are stored in cases 
provided for them; but if not used for forty-eight 
hours, are again sterilized before being used. 

Brushes. — Small hand brushes having a strong 
wooden back and stiff bristles are used for scrubbing 
the hands, field of operation, and the instruments. 
They should be boiled two hours before the operation, 
then placed in a jar containing a i : looo corrosive 
sublimate solution. A separate brush should be re- 
served for the patierrt, and should be so marked. A 
separate brush should also be used for the cleansing 
of the vagina or rectum. Brushes used in purulent 
wounds and cancer should be destroyed after the 
operation. The same brush should never be used 
twice by the same person without being resterilized, 
and no two persons should use the same brush. 

Drainage. — The object of drainage is to carry off 
to the surface the secretions and discharges of 
wounds arrd cavities. The retention and accumula- 
tion of these would interfere with healing, and, in 
the case of septic discharge, involves the danger of 
general infection. Drainage may be secured by 
means of rubber or glass tubes, or by strands of 
gauze, catgut, silkworm-gut, horse-hair, or silk. In 
case of abdominal section the glass drainage-tube is 
usually preferred to gauze drainage, because it gives 
freer drainage, does not require a large opening in the 



DRAINAGE. 1 6/ 

abdominal walls, and is less likely to cause hernia ; 
a sinus is more apt to follow the use of gauze drain- 



FlG. 150. — Drainage-tubes and syringe for sucking them out (Hirst). 

age, and without anesthesia its removal is painful. 
Gauze soils the dressings and edges of the wound. 
With the glass drainage-tube, if properly taken care 
of, the dressings can be kept as sweet and clean as 
when put on. By bacteriologic examination the se- 
cretions in the glass drainage-tube have been found 
on the third day free from pathogenic bacteria. The 
" cigarette drain " is made by rolling a loose twist of 
gauze in rubber tissue. The chief objections to 
drainage of dependent pockets in the pelvis or abdo- 
men, as formulated by Dr. J. G. Clark, of the Uni- 
versity of Pennsylvania, are, first, that the fluids are 
frequently not removed, but, on the contrary, are pent 
up by the gauze drain; and, second, instead of remov- 
ing infection, the gauze or tube may be the means 
of introducing it from the outside into the degener- 
ated fluids. To overcome the dangers of dependent 
pockets and dead spaces in the pelvis. Dr. Clark sug- 
gests the elevation of the patient's body after operation 
to a sufficient height to start the flow of fluids from the 



1 68 SURGICAL TECHNIC. 

pelvis toward the diaphragm, and thus promote the 
rapid elimination, by the normal channels of exit 
from the peritoneal cavity, of infectious matter, and 
of vital fluids that may stagnate in these pockets and 
form a culture-medium for pyogenic organisms. 

The technic of postural drainage through the ab- 
domen, which has met with such good results, is 
very simple. After the operation proper a large 
quantity of normal saline solution is poured into the 
abdomen and allowed to remain, and the foot of the 
patient's bed is raised twenty inches for about thirty- 
six hours after the operation. The result is that the 
exudate, if infected, is greatly diluted and may all 
be absorbed by the peritoneum; if inflammatory, it is 
kept liquid, and organized exudates are avoided. The 
pressure of the viscera is removed, intestinal adhe- 
sions are avoided, peristalsis does not cause pain by 
irritation, the patient suffers less distress and discom- 
fort, and convalescence is naturally more rapid ; Fow- 
ler's position seeks, by elevating the head of the 
patient's bed and slinging the individual from the 
shoulders, to prevent the spreading of a local peri- 
toneal infection upward toward the vital organs. 

Closure of the abdomen without drainage after 
thoroughly drying out the cavity is the rule of some 
operators, who believe that so-called drains for the 
most part act as foreign bodies. 

Care of Drainage-tubes, — If a glass drainage-tube 
is in the abdomen, the care of it is usually left to the 
nurse. She must, each time before drainage, thor- 
oughly scrub and sterilize her hands. A syringe is used 
to withdraw any fluid remaining and for injecting irri- 
gating solutions. The syringe must be washed first 



DRAINAGE. 1 69 

with boiling water, the water being passed through 
it several times, then with corrosive-sublimate solu- 
tion (i : icxx)), followed with boiling water; the 
syringe is then to be laid in the corrosive solution 
until the nurse has washed her hands a second time 
and unpinned the dressing covering the tube. The 
rubber tube attached to the syringe is passed down 
the center of the drainage-tube to the bottom, then 
withdrawn a little, so that only the fluid will be 
drawn up, and not the tissue of the pelvis. The 
syringe-piston is to be slowly and steadily drawn up. 
When removing the syringe the nurse should be 
careful that blood does not drop on the dressing. 
The mouth of the tube is to be covered while the 
syringe is being emptied, and the corrosive and hot 
water are to be passed through the syringe before 
again putting it down the tube. 

Some surgeons place a piece of twisted gauze into 
the tube, which sucks up the fluid. This gauze is 
changed at stated intervals, and the tube is cleaned 
with a small piece of sterilized cotton or gauze fast- 
ened on the end of a pair of long forceps; then a 
fresh twist of gauze is inserted. The amount of 
fluid drawn and its character must always be reported 
by the nurse. When the drainage-tube is to be 
removed, the nurse should observ^e the same precau- 
tions as she would for a dressing. 

Glass drainage-tubes are made aseptic by boiling 
for two hours before the operation. 

Pr^eparatioii of Rtibbej^ Drainage-Uibes. — Cut tubino; 
into desired lengths, slip each piece over a glass rod, 
and scrub with a stiff" brush and green soap. Rinse 
in sterile water until entirely free from soap. Boil for 



I/O SURGICAL TECHNIC. 

one hour in a i per cent, solution of sodium bicar- 
bonate (enough to impart a greasy feel to the water); 
rinse again several times in sterile water, and put into 




Fig. 151. — Drainage-tubes: a, glass; b, rubber. 

sterile jars and cover with alcohol or carbolic acid, 
I : 20. The jar is kept covered except when the 
tubes are being put in and taken out by sterilized 
forceps. 

Rubber Dam. — Rubber dam is sterilized by boil- 
ing in I per cent, soda solution, and is afterward 
transferred to a glass jar containing i : 20 carbolic 
acid solution. 

Cargile membrane, tissue made from the perito- 
neum of the ox, is used as a protective against adhe- 
sion formation, particularly in operations upon the 
bowels. 

Several years ago the reviser discovered a similar 
material to be very cheaply and easily obtained from 
vsharks. 

Gloves. — Rubber and cotton gloves are much 
employed in surgical work, and with very good re- 
sults. They prevent infection by the surgeon's and 
assistants' hands, which even with the greatest care 
cannot be rendered completely sterile. The cotton 
gloves are sterilized by dry heat. The rubber gloves 



GLOVES. 



171 



are sterilized by boiling one hour in a i : 20 solution 
of carbolic acid, after which they are transferred to a 
basin of sterilized water until required for use. To 
put them on, they are filled with sterile water until 
the whole glove becomes distended, after which they 
are easily slipped on. Some surgeons wear the 
gloves to protect the hands after they have been 




Fig. 152. — Finger cots. 



Fig. 153.— Rubber glove. 



sterilized and remove them when all is ready for the 
operation. The disadvantage of rubber gloves lies in 
their causing the wearer's hands to perspire, thereby 
increasing the danger of infecting the wound in cases 
of accidental puncture of the glove by knife or needle 
during operation. The same care must be used in 
scrubbing hands when rubber gloves are used as 
when they are not. Careless regard of this rule will 
end up sooner or later in infection from a punctured 
glove. 

Ruhber-glove Solution. — ]\Iurphy suggests an asep- 
tic film covering sufficiently tenacious to last during 
several hours' work, to be made by dipping the hands 
and arms into a 4 per cent, solution of pure gutta- 
percha chips dissolved in sterile benzine or acetone 



1/2 SURGICAL TECHNIC, 

(use chloroform or carbon tetrachlorid in place of these, 
owing to inflammability). The solution must not be 
boiled. Apply by immersion, allowing excess to drip 
from the fingers ; the acetone solution dries in a few 
seconds, that of benzin requires two or three minutes. 
Remove from the skin, which is left pliant, by wash- 
ing in benzin. 
Green Soap. — 

Caustic potash, 13 ounces. 

Linseed oil, 40 ** 

Alcohol, 4 ** 

Heat the oil in a vessel to 140° F. or till it is too hot 
for the fingers. Dissolve the potavsh in 6^ ounces of 
hot water. Add the alcohol and let it cool. Then add 
the heated oil, stirring constantly until mixed. Let 
the mixture stand twelve hours and add alcohol. 

To make a tincture of green soap: 

Green soap, 3 parts. 

Alcohol, 95 percent., 2 " 

Ether, i part. 

To prepare cold, mix and stir for a few minutes 
every hour until a clear solution is formed; or the 
soap may be melted first over a slow fire. Remove to 
a safe cool place, stir occasionally, and just before 
complete hardening recurs, add the alcohol and ether. 



CHAPTER XII, 



INFLAMMATION. 

Inflammation is the reaction of a part to an 
irritant. 

The first changes are in the vessels and circulation ; 
second, a passing out of fluids and solids from the 
vessels; and third, changes in the perivascular tissue 
— i. e,^ the tissues about the blood-vessels. These 





Fig. 154. — Normal vessels and 
blood-stream. 



Fig. 155. — Dilatation of the vessels 
in inflammation. 



(American Text-Book of Surgery.) 

three changes produce the characteristic phenomena 
of inflammation — heat, redness, swelling, pain, and 
loss of function. 

The first change in an inflamed area is a dilatation 
of all the vessels — the arterioles, capillaries, and 
venules. As a result, there is an increased activity 
in the circulation and an increased flow of blood to 

173 



1/4 SURGICAL TECH NIC, 

the part, a condition known as active hyperemia. 
After a time the blood-current begins to slacken; 
then the white cells approach the vessel-wall and 




Fig. 156. — Ice-bag (Ashton). FiG. 157. — Water coil. 

begin to pass through it (emigration of white cells). 
There is also a passing out of plasma or fluid from 
the blood, and in severe cases of inflammation the 
red cells may also pass out. If we now examine the 
inflamed area with a microscope, we find an enor- 
mous number of cells, chiefly white blood-cells, in 
the tissues about the vessels. Fibrin in the form of 
delicate granules and fibrils may also be present. 

Inflammation is a process which is directed to the re- 
moval of an irritant, which may be either a portion of 
an injured tissue or a foreign body or material. After 
this result has been accomplished healing or regen- 
eration takes place. If the inflammation was caused 
by bacteria, suppuration is likely to follow. In that 
case the tissues will liquefy and the cells will be 
thrown off suspended in a liquid (liquor puris), the 
whole being known as pus. In suppuration there is 
always loss of tissue, and healing, if it occurs, is 



INFLAMMA TION. 



175 



brought about through the formation of a scar. In 
order to produce healing granulation-tissue is formed. 




Fig. 158.— Bier's vacuum treatment apparatus for boils. 

Granulation-tissue consists of new cells and tiny capil- 
lary loops. It is sometimes called "proud flesh," and 
bleeds very easily. The scar has a marked tendency 
to contract and may cause great deformity. 




m 



Fig. 159. — Bier's air suction apparatus for treating stiff knee. 

Among the causes of inflammation are injuries, 
chemical irritants, heat and cold, and bacteria. 



CHAPTER XIII. 

CATHETERIZATION ; DOUCHES ; ENEMATA ; 
WASHING OUT THE BLADDER; LAVAGE. 

The use of the catheter is ordinarily very simple, 
and yet it may truthfully be said that there is no oper- 
ation which is performed with so little regard for asepsis. 
Asepsis and antisepsis are as important here as they 
would be in preparing for an abdominal operation. 

Cystitis is often caused by the introduction of germs 
into the bladder by means of a dirty catheter, or by 
not cleansing the external genitals, vestibule, and 
meatus before the operation. Normal urine is to be 
considered sterile unless there is some disease of the 
kidneys or bladder; and when infection occurs we 
may assume that the germs have gained entrance 
from without. The catheter may be of glass. When 
a glass catheter is not at hand, a silver or rubber 
one may be used. When of glass or silver or rubber it 
should be boiled twenty minutes before being used. 

Glass catheters are the best ; they are easily 
rendered aseptic, and show whether they are or are 
not perfectly clean. Sterilization is most important 
before using the catheter and immediately afterward. 
There is no danger of the catheter breaking, as so 
many patients fear, if it is not cracked before being 
introduced. Besides the catheter, which is taken to 
the bedside in a basin of very hot water, there are 

176 



INTRODUCTION OF THE CATHETER. 



177 



needed a basin of corrosive sublimate solution 
(i : 1000), sterilized gauze or cotton, and a vessel 
to receive the urine. A lubricant of sterilized oil 




Fig. 160. — Virginal vulva : i, Labia majora ; 2, fourchet ; 3, labia, minora ; 
4, glans clitoridis ; 5, meatus urinarius ; 6, vestibule ; 7, entrance to the vagina ; 
8, hymen ; 9, orifice of Bartholini's gland; 10, anterior commissure of labia 
majora; 11, anus; 12, blind recess ; 13, fossa navicularis ; 14, body of clitoris. 
(Modified from Tarnier.) 

to render the entrance of the instrument as easy as 
possible is used only when a gum-elastic or rubber 
catheter is employed. A mixture of carbolic acid 
solution (i :4o) and glycerin serves for this purpose. 

Introduction of the Catheter. — The patient lies 
on her back with the knees drawn up and sepa- 
rated, the upper clothing being divided over each 

knee to guard against unnecessary exposure. The 
12 



lyS SURGICAL TECHNIC. 

labia are separated with sterilized sponges and the 
parts washed with the corrosive solution. The 
catheter is inserted into the urethra, the opening 
of which is just above the vaginal entrance. If there 
is any difficulty, the catheter should be withdrawn a 
little, and gently pointed a little downward or up- 
ward, to the right or to the left. If the flow should 
cease before enough urine has been drawn, the cathe- 
ter is withdrawn a little or is inserted a little farther 
than before. Before removing the catheter a finger 
should be placed over its end, to prevent any drops 
of urine wetting the bed. After the operation the 
parts are again washed, and the catheter boiled and 
placed in a bottle containing a solution of carbolic 
acid (i : 20), unless the catheter is of rubber; for car- 
bolic acid ruins rubber. 

When the bladder is partially paralyzed from result 
of an operation, or otherwise, a rectal injection of 
very warm water will often cause the bowel and 
bladder to empty themselves at the same time, thus 
doing away with the necessity of using a catheter. 

The urine for examination by the physician is best 
drawn with the catheter, to prevent contamination 
from vaginal discharges. 

A distended bladder must be emptied gradually; 
several sittings, at intervals of four or six hours, may 
be necessary in some cases; and as the last amount of 
urine is being drawn the flow should be slowed, to 
prevent any injury to the mucous membrane of the 
bladder from drawing it into the eye of the catheter. 

Irrigation of the Bladder. — To irrigate the 
bladder a fountain-syringe, cleansed with boiling 
water and a disinfectant, is needed ; also a glass 
catheter, which is sterilized in the same way as for 



EXAMINATION OF STOMACH-CONTENTS. 1 79 

catheterizing. The parts, of course, are cleansed in 
the manner described. The patient is first catheter- 
ized; the catheter is then rinsed with boiling water 
and attached to the rubber tubing of the syringe 
which contains the irrigation solution (boric acid or 
salt solution), the temperature of the latter being 
about 100° F. The solution must run warm before 
the catheter is inserted. The rapidity of the flow is 
regulated by raising or lowering the irrigator. The 
quantity of solution introduced is governed by the 
feelings of the patient ; usually 200 c.c. is all that 
can be tolerated, after which the tube is disconnected 
and the fluid is drawn off. If a double catheter is 
used, the tubing is not removed. The irrigation is 
repeated until the washings come away perfectly clear 
and clean. 

iExamination of Stomach- contents. — Many 
times the nurse is called upon to give a test-break- 
fast and to send the stomach-contents to the labora- 
tory for examination. 

A test-breakfast usually consists of a cup of tea 
without milk or sugar, and two soda-crackers; or in- 
stead of the crackers a small piece of rare steak or 
small piece of bread without butter is given. One 
hour after, the stomach-contents are obtained bypass- 
ing the stomach-tube. As soon as the tube comes in 
contact with the walls of the stomach they contract 
and force out the contents. If vomiting does not 
occur, it may be excited by pouring down the tube 
about two drams of lukewarm water. The contents 
are measured, and placed in a clean bottle labelled 
with the patient's name, the date, quantity, and hour 
that the breakfast was given and contents secured; 
the bottle is then sent immediately to the laboratory. 



i8o 



SURGICAL TECHNIC, 



In cases where revulsion does not occur, pour a 
measured quantity of warm water (one pint) into the 
stomach, remove it, and secure the test meal by 
siphonage (lower the mouth of the stomach-tube 
below the level of the patient's stomach, when gravi- 
tation will cause the fluid to flow). 

Douches. — Properly given, the vaginal douche 
relieves inflammation, checks hemorrhage, acts as a 
stimulant and cleansing agent, and checks secretion. 
The amount of water used is from five to six quarts, 
of a temperature of iio° F. The temperature must 
always be tested with a bath- thermometer 
(Fig. i6i), not with the hand. The 
Baker douche apparatus (Fig. 162) is an 
excellent contrivance. In its absence 
a fountain-syringe may be used. 

-When taking a douche the patient 
should lie on her back, with the thighs 
flexed on the abdomen and the legs 
flexed on the thighs. In this position 
the water comes in contact with the 
whole vagina. 

The pail or fountain-syringe must be 
hung about four feet above the bed, so 
that it will take about twenty minutes 
for the water to run out. Air must be 
expelled, and the water must run warm 
before the tube is inserted into the vagina. 
The vaginal tube must always be steril- 
ized before and after using, and every 
patient should have her own tube. 

Many patients in private practice object 
to taking douches, and will neglect them on account 
of the inconvenience ; but this they can overcome by 



Fig. 161. — Bath 
thermometer. 



DOUCHES. 



I8I 



taking the douches in the bath-tub. Half-way across 
the bottom of the tub a piece of board is placed, on 
which the patient can lie. The douche-board designed 




Fig. 162. — Apparatus for vaginal douche. 

by Prof. Byron Robinson, of Chicago, has proved very 
beneficial and convenient to patients by giving them 
a comfortable and simple method of taking a douche. 




Fig. ■ 163. — Douche-pan. 

It can be used without legs, on a bath-tub, and with 
legs (some twelve inches long) may be used in any 
room. 

Antiseptic Douches. — Corrosive sublimate, carbolic 
acid, creolin, and boric acid are used for antiseptic 



1 82 



SURGICAL TECHNIC. 



douches ; and to prevent absorption and irritation 
a plain Vv^ater douche is often given after any of 
these antiseptics. / 




Fig. 164. — Douche-board. 

After any intra-uterine douche too forcibly given 
uterine colic with dangerous collapse may occur. 

A patient should lie quietly for one hour after tak- 
ing a douche; if only one is used a day, it is best to 
give it at night, because then the uterus is most con- 
gested and needs the hot water most, and the tempo- 
rary weak feeling which follows a douche will be gone 
before morning. 

Rectal Injections (i^nteroclysis) and Irriga- 
tion. — The therapeutic range of this procedure is not 
confined to the treatment of local troubles. It has 
long been used as a means of cleansing the lower 
bowel of accumulated feces. In the treatment of 
rectal ulcers and inflammations it has been employed 
both to relieve the irritation produced by fecal matter 
and to apply various medicaments to the parts. For 
the prevention of shock normal saline solution is 



RECTAL INJECTIONS. 1 83 

injected — one or two pints. This, by filling the 
blood-vessels, enables the patient to withstand the loss 
of blood from the nerve-centers. After the operation 
shock and hemorrhage are counteracted by its use, 
and at the same time the thirst is relieved and rest- 
lessness quieted. In septic conditions, both local and 
general, by diluting the toxic materials in the circu- 
lation and promoting their excretion by the skin, 
kidneys, and bowels, saline rectal injections play ah 
important part in the treatment. 

In patients whose digestive tracts are too weak to 
hold food or medicine rectal feeding or rectal medi- 
cation is employed. The rectum should be washed 
out thoroughly before the injection is given. If the 
rectum is intolerant and will not retain what is in- 
jected, it is well to turn the patient on her left side 
and raise the hips on a pillow or a folded blanket. 
A long rectal tube should be used as for a high 
enema. The physician will give directions as to the 
temperature of the solution. In fever patients and 
in the hemorrhage of typhoid fever great relief and 
comfort are afforded by using very cold or iced water. 
In shock or hemorrhage a temperature of 100° F. is 
usually preferable. In long-continued lavage for 
local trouble the patient's preference as to the tem- 
perature is generally consulted. 

A stimulating and nutrient enema, black coffee, 
or hot saline solution is given when symptoms of 
shock appear either during or after an operation ; 
it should be injected high up into the colon. The 
rectum should be thoroughly cleansed at least once 
daily with warm saline solution, which will also 
aid the absorption of the nutrient enema. When 



1 84 



SURGICAL TECHNIC. 



feeding by rectum in gynecologic cases, it should 
be remembered that tight tamponing of the vagina 
may interfere with absorption in the rectum. If the 
presence of hemorrhoids is a drawback, a 2 per cent, 
solution of cocain may be used before injecting the 
fluid. 



Stimulating enema : 




Whiskey, 


2 ounces. 


Ammonium carbonate, 


15 grains. 


Beef-tea, 


4 ounces. 


Or 




Brandy, 


2 ounces. 


Tincture of digitalis. 


20 minims, 


Milk, 


4 ounces. 


For tympanites : 




Tincture of asafetida, 


2 ounces. 


Spirits of turpentine, 


I ounce. 


Magnesium sulphate (Ep- 


som salt). 


2 ounces. 


Warm water. 


I pint. 



Purgative enemata : 

1. Warm soap-suds, ^ pint. 

2. Common black molasses, 12 ounces^ 



Warm soap-suds. 


16 " 


Molasses, black. 


4 ounces. 


Glycerin, 


4 " 


Magnesium sulphate. 


I ounce. 


Spirits of turpentine. 


I " 


Warm soap-suds. 


8 ounces. 



RECTAL INJECTIONS. 



185 



4. Glycerin, 4 ounces. 
Turpentine, i ounce. 
Magnesium sulphate (Ep- 
som salt), 2 ounces. 

5. Inspissated ox-gall, 
Warm water, 

6. Spirits of turpentine, 
Mucilage of acacia. 

To be given high. 

7. Senna, 
Magnesium sulphate, 
Olive oil. 
Boiling water, 

Infuse the senna in the water. Then dissolve 
the magnesia, add the oil, and thoroughly rm.^ 
by stirring. 



^ ounce. 
I quart. 

10 drops. 
V^ ounce. 



^ ounce. 

I '' 
I pint. 



CHAPTER XIV. 
MINOR SURGICAL PROCEDURES. 

Hypodermic Injection.— This procedure is em- 
ployed to secure rapid medication or in obtaining 
local anesthesia by the injection method. When 
used in the latter capacity it is called interdermic 
injection. 

The aseptic method of employment requires that 
the syringe, needle, and solution should be sterile. 
To cleanse the skin about the point of intended 




Fig. 165. — Method of reducing primary puncture pain in cocainization or 
hypodermic injection. 

puncture use first soap and water. Apply ether, 
alcohol, or tincture of iodin to render the site sterile. 
Insert the needle-point at the summit of a pinched- 
up fold of the sterilized skin (Fig. 165). For hypo- 
dermic medication the skin of the arm, forearm, or 
the thigh may be selected, fleshy parts favoring rapid 
absorption. Avoid superficial veins and deeper ves- 
sels, as direct entry of the drug into the blood-current 
might give rise to a too rapid effect. 

186 



MINOR SURGICAL PROCEDURES. 1 8/ 

Counter-irritation. — Counter-irritation or revul- 
sion is a method of producing artificial irritation 
upon one portion of the body surface to alter the 
progress of disease in distant parts. It acts directly 
by drawing blood away from the diseased area or 
through the nervous system, and may be used in 
cases of localized inflammation or congestion to 
overcome neuralgic pain and in conditions of gen- 
eral depression or shock. 

The methods employed may be mild or severe in 
their effects. Of the milder means used for the pur- 
pose the mustard foot-bath is one of the best. It 
consists in soaking the feet and legs of the patient 
in a bucket two-thirds full of water at a temperature 
of from iio° to 140° F., to which has been added 
one to two tablespoonfuls of ground mustard. The 
patient's body should be protected by blanketing 
during the bath, which may continue for from ten 
to twenty minutes. Tincture of iodin is used for a 
similar purpose in chronic inflammation of joints or 
glands. It may be applied with a swab or brush to 
the parts. Application must not be made oftener 
than once in two to four days to patients having 
tender skins. 

MiLstard-plaster^ made by mixing up one part of 
ground black mustard to five parts of wheat flour or 
flaxseed in a little water, and applied upon a cloth 
or folded newspaper to the parts, will often prove 
useful in widespread inflammation or irritations. A 
fresh mustard-plaster should not be applied for a 
longer period than twenty or thirty minutes, else it 
may give rise to local injury to the skin and directly 
underlying tissues. 



1 88 SURGICAL TECHNIC. 

Turpentine Stupe. — This method of producing 
counter-irritation consists in the application to the 
inflamed parts of a flannel cloth which has been 
wrung out in hot water and sprinkled or dipped and 
wrung out in either the spirits or oil of turpentine. 
The skin should be anointed with vaselin if the 
application causes too much pain or irritation. 
Spice-plasters or bags are often ordered in the treat- 
ment of children. The mixture consists of equal 
parts of ground ginger, cloves, cinnamon, allspice, 
to which add and thoroughly mix one-fourth part 
of Cayenne pepper ; wet with hot water, alcohol, or 
whiskey before applying. The so-called warming 
plaster consists of Burgundy pitch 12 parts, canthar- 
ides cerate i part. 

Heat and cold are identical in effects. 

Use. — (i) lyocally as a stimulant (if of moderate 
intensity and applied but for a short time and if fol- 
lowed by immediate reaction) ; also as a sedative (if 
of long application, very intense, and if no reaction 
occurs). (2) Constitutional : {a) Heat may be used as 
a pyretic in shock, collapse, insanity ; (J?) cold as an 
antipyretic in acute fever, sunstroke. 

Application. — (i) Heat. — {a) Diy (in the form of 
hot-water bags or bottles, hot bricks, hot sand or 
salt bags, heated stovelids, hot-air-oven apparatus 
(Fig. 166), hot blankets) ; (b) Moist, poultice (flaxseed, 
oatmeal, or hops, mixed with water, is sterilized by 
boiling) ; hot bath ; hot pack ; hot douche ; hot fomen- 
tation (gauze, flannel, or towel wrung out in hot water, 
hot antiseptic solution ; change when cooled). A ready 
method of producing diaphoresis (sweating) is by pour- 
ing water upon hot bricks wrapped in flannel. 



MINOR SURGICAL PROCEDURES. 



189 



(2) Cold. — id) Dry (applied in the form of crushed 
ice in thin rubber bags, bladders, ice water passed 
through coils of rubber tubing) ; cold air (by expos- 
ure) ; (b) Moist (irrigation, ice-water compresses, cold 
pack — wringing sheet out in ice water and wrapping 
it around the patient. Keep it wet by sprinkling) ; 





Fig. 166. — Hot-air oven. 

tepid bath (gradually reduced) ; sponge-bath (keep 
the patient's body-surface moist, fanning him all the 
time) ; alternating douche of hot and of cold water. 

Vaccination. — Vaccination is the inoculation of 
an individual with the virus of cow-pox. 




Fig. 167. — Mareschal's individual vaccination stylet. 

The implements needed are a needle, lancet, or 
ivory point (Fig. 167); fresh virus (bovine or human- 
ized). 

Vaccination is performed as follows : {a) Render 
skin surface aseptic (select by choice upper and outer 
third of arm, inner side of thigh) ; ih) abrade the skin 



190 SURGICAL TECHNIC. 

until serum exudes ; (c) carefully work in the moist- 
ened virus ; {ct) protect surface of spot until dry. 
Avoid exposure. 

The times to perform vaccination are : (i) About 
the third month ; (2) seventh year ; (3) at puberty ; 
(4) repeat whenever small-pox is prevalent. 

I/iniments. — These are local stimulants useful in 
mild neuralgic or rheumatic pains : {a) Ammonia ; 
(h) chloroform ; {c) camphor ; (^) turpentine. Apply 
upon a cloth or by rubbing into the parts for a period 
of from five to twenty minutes ; anoint with vaselin 
after each application to prevent abrasion. 

Ointments. — Mildly stimulating and emollient: 
id) Mercurial (blue ointment) ; {B) ichthyol ; (c) bella- 
donna ; {d) boric acid ; {e) resorcin ; {f) iodin. Do 
not use iodin locally where there will be a possibility 
of a future cutting operation, because the skin be- 
comes like leather and heals badly. 




Fig. 168.— Dry cup. 



Ointments should be applied upon gauze or lint, 
nicked to allow for the escape of discharge if present. 

Cupping. — I. Dry Cups. — In dry cupping no 
blood is lost (Fig. 168). The operation is performed 



MINOR SURGICAL PROCEDURES. I9I 

by means of special cupping-glasses or wineglasses. 
Exhaust the air by burning a little roll of paper, 
piece of lint, or paper dipped in alcohol and lighted. 
Before the flame is extinguished rapidly invert the 
glass upon the skin surface. 

2. Wet Cups. — {a) Prepare the skin by cleansing 
with soap and water, dry thoroughly, and apply dry 
cups ; {b) scarify with a bistoury or by means of a 
spring scarificator upon the cupped sites ; (c) reapply 
the cups to the incised areas ; {d) treat the scarifica- 
tion wounds antiseptically. 

Cupping is employed to produce local depletion ; 
wet cups are better in serous inflammations. 

IVeecliing". — («) American leech (draws about a 
teaspoonful — 4 c.c. — of blood). 

{b) Swedish leech (draws three or four — 12-16 c.c. — 
teaspoonfuls). 

A mechanical leech consists of a scarifier, cup, and 
exhausting air-pump attachment. 

Method. — Prepare the skin surface by cleansing 
with soap and water ; dry thoroughly ; apply the 
leech to the area moistened with blood or milk ; 
confine the leech to the moistened area by means 
of an inverted glass tumbler. To remove the leech 
sprinkle a little salt upon its head. To preser\^e the 
life of the leech, strip it of the sucked blood and re- 
place in a jar of water having a perforated cork. Dress 
the wound antiseptically ; apply a compress, nitrate of 
silver torsion (acupressure), for continuous bleeding. 

Leeching is employed to secure local depletion. 

Scarification. — This consists in the making of 
small linear incisions through the skin and subcu- 
taneous or mucous tissues for the purpose of securing 
local depletion to relieve tension. 



192 SURGICAL TECHNIC. 

Puncturation is the operation of making punc- 
tures with a sharp-pointed bistoury through the skin 
or mucous tissues. It is performed to secure local 
depletion or to relieve pressure. 

Deep puncture and incision with a sharp-pointed 
bistoury is sometimes performed — ia) To relieve ten- 
sion ; (Z*) to secure drainage. 

Plasters. — {a) Belladonna (use as a local sedative 
in neuralgia, mastitis, adenitis ; remove if dryness 
of throat or disordered vision occurs — the first symp- 
toms of belladonna-poisoning) ; {b) mercury (used for 
its resolvent effect upon indurated glands, chronic 
arthritis); {c) adhesive, "American surgeon's adhe- 
sive plaster" (contains rubber, and adheres without 
heating) ; (d) resin plaster (requires heating to adhere). 

Collodion and cotton are used to support and 
seal external flaps and wounds. 

Massage. — Massage consists of manual manipu- 
lations of a part for the purpose of stimulation. 
May be applied twice daily, once daily, or every 
other day ; each application may last from twenty 
minutes to one hour. 

The movements of massage are — (i) Rubbing 
(stroking movements, gentle at first, afterward of 
increasing firmness) ; (2) kneading (rolling, circular, 
pinching movements) ; (3) tapping (percussion over 
the surface with the leveled finger-tips produced by 
flexion, ulnar side of the hand, or by the use of a 
mechanical muscle-beater); (4) passive motion (ele- 
vation, flexion, and contraction of the parts produced 
by the operator). 

Clinical Thermometer.— May be of Fahrenheit 
(common form) or Centigrade scale. To reduce read- 



MINOR SURGICAL PROCEDURES. 



193 



ings — (i) Fahrenheit to Centigrade: Subtract 32 from 
the number of Fahrenheit degrees and multiply the 



Fig. 169. — Clinical thermometer. 

remainder by f ; (2) Centigrade to Fahrenheit : Multi- 
ply the number of Centigrade degrees by f and add 32. 

Thermometers may be — ia) straight, self- register- 
ing (90° to 110° F.— 33.3° to 44.4° C); (^) surface, 
coiled or bulb (80° to 110° F.— 26.6° to 44.4° C). 

Temperature may be taken in — [a] Mouth ; (b) 
axilla ; (c) rectum ; {d') vagina. Most exact in vagina 
and rectum. Mouth-temperature is higher than that 
of the axilla and less than that of the rectum. 
Axilla-temperature is somewhat less than a degree 
below the rectal. 

l^lectricity is used — {a) x\s a muscle tonic ; {b) for 
nerve-sedative action employ that form of electricity 




Fig. 170. — Electric brush. 



w^hich gives the best contractions with the least 
amount of pain and discomfort to the patient; for 




Fig. 171. — Electrolysis needles. 

implements required see Figs. 170, 171; [c] electrolysis 
(used in the treatment of aneurysm, tumors, for the 

13 



194 SURGICAL TECHNIC. 

removal of superfluous hair) ; {d) cautery, ecraseur 
(is followed by least hemorrhage when used at a dull 
red heat). 

POISONS AND ANTIDOTES. 

Acids^ Mineral. — Give chalk, flour, white of ^%%^ 
magnesia (plaster torn off the wall may be used in an 
emergency) ; a solution of carbonate of soda ; emol- 
lient drinks ; fixed oils (sweet oil, olive oil, cod-liver 
oil). Give plenty of water to dilute the acid. 

Acid^ Carbolic. — Any soluble sulphate (magnesia), 
alcohol acts as a direct antidote if given during the 
first ten or fifteen minutes ; whiskey may be employed 
for the purpose. 

Acid^ Hydrocyanic. — Secure plenty of fresh air; 
carry on artificial respiration ; apply cold affusion ; 
ammonia — inhalation and intravenously in a vein 
of the leg. 

Aconite. — Give emetics; stimulants (external and 
internal) ; keep up the body-heat ; patient is to be 
placed flat on his back. 

Antimony Tartrate. — Give vegetable acids — tannic 
acid (gr. v-xv — 0.333-1 gm.), catechu (f3J-ij — 4-8 
c.c). 

Arsenic. — Give freshly precipitated hydrated ses- 
quioxid of iron (made by adding magnesia to any 
iron solution). 

Atropin^ Belladonna^ Stramo7zitim. — Emetics (mus- 
tard flour in water) : apply cold to the head ; give 
physostigma (gr. yV~5 — 0.006-0.013 gm.) or pilo- 
carpin (gr. -I- — 0.008 gm.). 

Cantharides. — Give emetics; emollient drinks; 
opium (gr. \-\ — 0.016-0.033 gm.) by mouth and 



POISONS AND ANTIDOTES. I95 

rectum ; large draughts of water to flush the kid- 
neys. 

Chlovin-zvater. — Give albumin (white of ^'g%^ milk, 
flour). 

Chloroform. — Secure plenty of fresh air, carry on 
artificial respiration (inclining head down, pull the pa- 
tient's tongue forward) ; brandy and ammonia intrave- 
nously in leg ; hypodermic injection (15 min. — i c.c.) 
of tincture of digitalis; gr. -^-^{p.oo\ gm.) of atropin. 

Colchicum. — Give emetics, followed by demulcent 
drinks; keep up external heat. If coma is present, 
brandy, ammonia, coffee. Opium in large dose. 

Co7tium. — Give emetics ; stimulants (external and 
internal). 

Copper Sulphate. — Give yellow prussiate of potash 
(may be given freely if pure) ; soap. 

Corrosive Sublimate. — Give albumin (white of ^^<g 
— 4 gr. (0.266 gm.) of sublimate requires the white 
of one ^'g'^ ; flour ; milk ; equal parts of lime-water 
and milk ; emetics or stomach-pump. 

Croton Oil. — Give emetics ; wash out the stomach ; 
mucilaginous fluids containing opium. 

Digitalis. — Give emetics; recumbent position; 
tincture of aconite (1-5 drops — 0.066-0.333 c.c); 
opium (gr. f-^— 0.16-0.033 g^-)- 

Elaterium,. — Give demulcent drinks; enemata of 
opium ; external heat. 

Hyoscyamus. — Stomach-pump ; give emetics ; stim- 
ulants (external and internal) ; physostigma (gr. y^Q- - 
0.006 gm.); pilocarpin (gr. \ — 0.008 gm.). 

Illuminating-gas. — Hypodermic injection (i min. 
— 0.066 c.c.) of nitroglycerin; carry on artificial 
respiration. 



196 SURGICAL TECHNIC. 

lodin. — Give emetics; demulcent drinks (starch 
or flour in water); opium (gr. ^\ — 0.016-0.033 
gm.); external heat. 

Lead Salts. — Give any soluble sulphate (magnesia 
or soda). Follow with emetics, opium (gr. \-\ — 
0.016-0.033 gm.), and milk. 

Lobelia. — External and internal stimulation. 

Morphiii; Opium. — Atropin (gr. 5-J-Q — 0.006 gm.) 
hypodermically until respirations number eight a 
minute ; stomach-pump ; stimulants (external and 
internal) ; brandy ; strong coffee ; cold affusion ; 
ammonia to nostrils ; galvanic shocks ; compelling 
patient to move about ; artificial respiration ; per- 
manganate of potassium; cocain (gr. \-\ — 0.016- 
0.033 Z^^' J repeat if necessary. 

Oxalic Acid. — Give lime (plaster, lime-water, milk 
of lime). 

/%(9J^/^6>r^/J•.— Sulphate of copper in emetic dose as 
a chemic antidote ; emetics; purgatives. No oils. 

Potash and Soda Salts. — Dilute acetic acid; citric 
acid ; lemon-juice ; vinegar ; fixed oils ; demulcent 
drinks. 

Silver Nitrate. — Solution of common salt ; demul- 
cent drinks ; emetics. 

Strychni7i ; Ntix Vomica. — Give 30 grains (2 gm.) 
of chloral and 60 grains (4 gm.) of bromid of potas- 
sium ; nitrate of amyl. 

Tobacco. — Emetics; stimulants (external and inter- 
nal); strychnin (gr. ^^o~r5 — 0.0022-0.0044 gm.). 

Zijic Salts. — Carbonate of soda; emetics; warm 
demulcent drinks. 

Poisonous Fish. — Emetics to wash out the stomach ; 
purgatives ; stimulants. 



CHAPTER XV. 
OBSTETRICAL NURSING, CARE OF INFANTS, ETC. 

Professor Hirst has employed printed slips con- 
taining the following directions to the nurse : 

BEFORE LABOR. 

I. Have ready towels ; ether, J lb. ; brandy, 2 oz. ; 
vinegar, 4 oz. ; hot water ; a bottle of antiseptic tab- 
lets ; a large, new sponge ; a roll of narrow tape or 
skein of bobbin ; a fountain-syringe ; bed-pan ; new, 
soft-rubber catheter ; 4 dozen small, 2 dozen large, 
pads ; small package of salicylated cotton ; absorbent 
cotton. 

n. Give a rectal injection (a pint of soapsuds with 
teaspoonful of turpentine) as soon as labor-pains are 
well established. 

AFTER LABOR. 

III. No vaginal injection to be given unless 
ordered. 

IV. Take the temperature three times a day — 
morning, noon, and evening. 

V. Place large pad under patient. Occlusive 
bandage to be used as directed. 

VI. The external genitals to be w^ashed off four 
or five times a day with a warm corrosive sublimate 
solution, I : 2000. Use absorbent cotton. 

VII. If, at the end of twelve hours, the bladder 

197 



198 SURGICAL TECHNIC. 

cannot be emptied naturally, use a catheter. After- 
ward, if necessary, catheterize patient three times a 
day. 




Fig. 172. — Bed arranged tor childbirth : The mattress is protected by a 
mackintosh, over which a clean sheet is spread. The upper bedclothes are 
rolled up at the foot of the bed. The woman's buttocks rest upon a square 
yard of nursery cloth. The chair is for the obstetrician ; at his feet is a 
waste-bucket, into which the pledgets of cotton used to clean the anus are 
thrown. The table, in easy reach, has upon it a large basin of sublimate 
solution, I : 2000, in which are many large pledgets of cotton; a small tin 
cup on an alcohol lamp to boil the scissors for the cord ; a half dozen clean 
towels ; a pot of carbolated vaselin • a tumbler of boric-acid solution with 
squares of clean soft hnen in it for the child's eyes and mouth ; a tube of 
sterile silk for the cord (Hirst). 

VIII. The patient is to lie on her back ; she may 
be moved from one side of the bed to the other sev- 
eral times a day ; her limbs may be rubbed with alco- 
hol and water or bathing whiskey once a day. 



OBSTETRICAL NURSING, CARE OF INFANTS. 1 99 

IX. The nurse's hands are to be washed with nail- 
brush, soap and water, and rinsed in a i : 3000 sub- 
limate solution before catheterizing the patient, 
cleansing the genitals or breasts. 

Diet. — First 48 Hours. — Milk, i>^-2 pints a day, 
gruel, soup, one cup of tea a day, toast and butter. 

Second 4.8 Hours. — I\Iilk-toast, poached eggs, por- 
ridge, soup, corn starch, tapioca, wine jelly, small 
raw oysters, one cup of coffee or tea a day. 

Third 4.8 Hours. — Soup, white meat of fowl, 
mashed potatoes ; beets in addition to above. 

After sixth day return cautiously to ordinary diet. 
In addition to three meals a day give three or four 
glasses of milk through the day. 

Child. — I. After being well rubbed with sweet oil, 
the child is to be bathed in water of 90+° F. ; this 
should be the temperature of the daily bath. Use a 
bath thermometer, or else the water will often be 
too hot. 

II. The cord is to be dressed with salicylated cot- 
ton. Observe carefully for bleeding. 

III. It should be bathed daily, about mid-day, in 
the warmest part of the room. Use Castile soap and 
a soft sponge ; avoid the eyes. 

IV. The bowels of a healthy infant are moved four 
times a day, the urine voided six to twenty times. 
It is usually necessary to change the diapers eighteen 
to twenty-four times a day. Use compound or 
borated talcum powder, lycopodium, zinc oxid, or 
rice flour. In case of chafing, cold cream and borated 
talcum flour. Note the color of stools. 

Nursing. — The child is to be put to the breast 
every four hours during the first two days. No other 



200 



SURGICAL TECHNIC. 



food is to be given it. After the second day it should 
be nursed every two hours, from 7 a.m. to 9 p.m., 
and. twice during the night (i a.m. and 5 a.m.). 
After every nursing the nipples are to be carefully 
washed wath a piece of absorbent cotton, warm water, 
and Castile soap, and then smeared with a little sweet 
oil. 




Fig. 173. — The Murphy breast-binder. 

Clothing. — If born during the winter season a 
baby should be clothed as follows : A binder of flan- 
nel or knit wool twice around abdomen, a knit shirt, 
diaper, knit woollen shoes, and two skirts, the first 
flannel (in midsummer, linen), and finally its dress. 
The skirts should be supported from the shoulders 
by sleeves or tapes. A knit jacket may be worn 
over the dress. A light flannel shawl or cap will 
protect the child from attacks of head cold (coryza). 

Feeding.— '^\i^ average stomach capacity of a new- 
born infant is one ounce, and it increases one ounce 
per month up to six months. A child should never 
be nursed while it lies in its crib, but be taken up in 



OBSTETRICAL NURSING, CARE OF INFANTS. 201 

the arms. Young mothers experience great pleasure 
in suckling a child, and may put it to the breast every 
fifteen or thirty minutes, giving rise to derangement 
of the infant's bowels which may become serious. 




Fig. 174- — Schultze's method of artificial respiration: A, Inspiration; 
B, expiration (Hirst). 

Artificial Feeding, — Asses' and goats' milk are 
most like human milk. An infant cannot begin to 
digest starchy foods under nine months of age, hence 
all prepared foods are injurious according to the 
amount of starch contained. 

Milk Mixtures. — (a) For first twelve or fourteen days 
take : 

Condensed milk, i teaspoonful. 

Boiled water, 3 tablespoonfuls. 

Cream, i teaspoonful. 

Lime water, i " 

Stir. 



202 



SURGICAL TECH NIC. 



{b) After fourteenth day up to third month the 
following may be used : 



Milk, 

Boiled water, 
Cream, 
Ivi me- water, 
Mai tine (Merck's), 
Stir. 



I tablespoonful. 
5 teaspoon fuls. 
I teaspoonful. 

I u 

lo grains. 



After the third month increase the amount of milk 
to 5 teaspoonfuls, and reduce the boiled water to 4 
teaspoonfuls. 

{c) A mixture for general use may be made accord- 
ing to the following formula : 

Milk, I ounce, 
Boiled water, i ounce, 
Cream, 
lyime-water, 

Malt sugar (malt extract), 
Stir together. 

Absolute cleanliness of all milk bottles, spoons, 
dippers, and rubber nipples is necessary, or deranged 
digestion if not serious bowel disorders will assuredly 
result. 



2 tablespoonfuls. 

2 

2 teaspoonfuls. 

2 

I cofifeespoonful. 



CHAPTER XVI. 

OPERATIONS ; PREPARATION OF THE OPERAT- 
ING-ROOM; THE SURGEON AND HIS 
ASSISTANTS. 

SuRGKRY has two objects, to prolong life and to 
relieve suffering. If it accomplishes either of these 
objects it succeeds. To prolong life or to relieve suf- 
fering divides operations into several classes, because 
they occur with more or less urgency according to 
the condition the patient is in. 

We often hear it said of an operation that it is one 
of necessity; of another, that it is one of emergency; 
and of another, that it is one of expediency. For 
convenience, operations are divided into two classes. 
First, operations of necessity; second, operations of 
expediency; and the first class may be subdivided 
into emergency and elective operations. 

Operations oi expediency are those which it would be 
well to perform for the health of the patient, as, for 
instance, the removal of a malignant growth of the 
breast. If left to itself, the growth will slowly and 
gradually invade the internal organs and in a very 
few years will end life; while if removed, the patient 
will in all probability live a number of years, and 
there may be immunity for a long period before the 
disease returns. 

203 



204 SURGICAL TECHNIC. 

Operations of necessity are performed to save the 
life of the patient, as, for example, in cases of intes- 
tinal obstruction, in hemorrhage from rupture of an 
extra-uterine pregnancy, etc. 

Emergency operations are those which must be 
performed immediately, without any choice, such 
as tracheotomy. 

An elective operation is at the choice of the patient; 
if done at all, it is only as a last chance and forlorn 
hope. 

Preparation of the Operating-room. — The op- 
erating-room should be made as aseptic as possible; 
the walls and floor should be washed with corrosive- 
sublimate solution (i : 2000). The operating-table, 
stands, chairs, and other furniture, which are usually 
of glass and iron, should be washed with the subli- 
mate solution. The sterilizer, which has been packed 
with the dressings, blankets (2), sheets (2), towels, 
caps, suits, and gowns for the operator, assistants, 
and nurses, should be started two hours before the 
operation. The instruments should boil half an hour 
before the operation in a i per cent, soda solution. 
Everything that will be needed for the operation and 
for possible accidents must be in the operating-room, 
and within easy reach. The solutions used should be 
quite warm, both for the surgeons and patient. We 
often come across a nurse who when she has filled 
the basins will put in her dirty hand to see if the 
water is too hot or too cold. We can readily tell 
from the outside of the basin if the water is of the 
proper temperature. 

At all major operations four nurses are necessary — 
^the head nurse, who has charge of the instruments; 



PREPARATION OF THE OPERATING-ROOM. 205 

a second nurse, to take charge of the sponges; a third 
nurse, to keep ready for the operator a basin of ster- 
ile water to enable him at any time to quickly rinse 
his hands to remove septic fluid or to free his fingers 
from blood and clots, and attend to the irrigation, 
etc. ; a fourth nurse, to handle unsterilized articles. 
Bach nurse should have a clear idea of her duties, 
and discharge them without undertaking the duties 
belonging to another. If the dry technic is used, the 
head nurse can hand the sponges as well as the in- 
struments, and this gives a nurse to wait on her exclu- 
sively. Under no consideration should the head 
nurse be left alone for a single moment, as the 
operator might call for something which she, being 
"surgically clean," could not touch, and so cause a 
probable delay in the operation. 

The duties of the nurses in the operating-room are 
the same for all operations. The dress must be of 
washable material, preferably white; it should be 
fresh for the operation and as far as possible sterilized. 
A dress that has been throuQ^h the wards is not 
clean; neither is one that has been worn a day or 
half a day. The dress-sleeves should be unbuttoned, 
so that they can be rolled up above the elbow, to allow 
the arms to be made as sterile as possible, and so 
that the sleeves may not come in contact with any- 
thing used in the operation itself. The finger-nails 
must be cut short. On first going to the operating- 
room the hands and forearms should be scrubbed with 
a brush and green soap and running water as hot as can 
be borne for ten minutes by the clock. The cleaning 
of the finger-nails is very important, as many of us 
would be surprised to find the large number of germs 



206 SURGICAL TECHNIC. 

taken from under the finger-nails as the result of one 
cleansing. 

The hands and forearms are then rendered absolutely 
sterile by putting them first into a saturated solution of 
permanganate of potassium until they are of a deep- 
brown color from the tips of the fingers to the elbow, 
then into a hot saturated solution of oxalic acid until 
all the permanganate stain has been removed; they are 
then washed in sterilized hot water, and finally are 
soaked for three minutes in a solution of corrosive 
sublimate (i : looo). The solutions reach those corners 
and crevices in the finger-nails that cannot be reached 
by the brush. 

Some surgeons prefer ether and alcohol for cleans- 
ing the skin. After the hands have been scrubbed 
thoroughly in hot soap-suds and the finger-nails 
cleaned, the hands are washed in ether, which re- 
moves from the skin all oily and fatty substances; 
they are next washed in pure alcohol for one minute, 
and finally soaked for three minutes in a solution of 
corrosive sublimate (i : looo). The field of operation 
is cleansed in the same manner with ether, alcohol, 
-and the sublimate solution. 

The nail-brushes used should be absolutely sterile. 
They must be new, and need to be boiled for two 
hours on the day before the operation, and then put 
into a glass jar containing corrosive sublimate 
(i : looo). A dirty nail-brush is the haven of myriads 
of germs and their spores, and by using such a one 
we place more germs on our hands than were there 
before they were touched. 

In some hospitals it is the custom to put on ster- 
ilized rubber gloves, to protect the hands from con- 



Plate 3. 




PREPARATION OF THE OPERATIXG-ROOM. lOJ 

tainination until the operation begins. The nurses 
next put on sterile caps and gowns. After making 
the hands aseptic it is essential that they do not come 
in contact with anything that has not been made 
aseptic before the operation is commenced, for such 
is vet}' easy to occur unless the nurse is constantly 
on her guard against it. 





Fig. 175. — a. Long-sleeved gown ; b, the same, showing glove with gauntlet 
turned up over wristband of gown (Hirst). 

The surgeon and his assistants prepare for the 
operation very much the same as does the nurse. 
Many surgeons before operating take a corrosive- 
sublimate bath (i : 500), after which they put on 



208 SURGICAL TECHNIC. 

clean linen suits or long gowns and prepare their 
hands and forearms, after which they put on sterilized 
suits. The suits, which have been sterilized in bags 
or folded in a sheet, are taken from the sterilizer by 
the head nurse, and placed in the dressing-room about 
one hour before the arrival of the surgeons, so that they 
may be perfectly dry when required for use. They 
should not be hung over the back of a chair, or laid 
over a table for dust to collect upon them. We must 
bear in mind that after sterilization there is always 
the danger of contamination, and the articles must 
be carefully protected as soon as they are removed 
from the sterilizer. To avoid confusion, each suit 
and bag should be distinctly marked with the owner's 
name, as should also the white canvas shoes which 
some surgeons wear. The caps must be laid in the 
dressing-room, together with long strips of sterilized 
gauze to cover the beard and mustache. 

Spectators should remove their coats and wear long 
linen gowns. The nurses should not leave the 
operating-room unless it is absolutely necessary, and 
there should be no unnecessary opening of doors, 
which allows cold air to enter. Constant moving 
also causes dust to become stirred up. The tem- 
perature of the operating-room should be 80° F., and 
the air kept perfectly pure by thorough ventilation, 
which should be so arranged that draughts will be 
avoided. 

With the kind permission of Dr. F. W. Johnston, 
of Boston, I extract the following from his paper on 
''Two Years' Work with the Sprague Sterilizer in 
the Gynecologic Department at St. Elizabeth's Hos- 
pital, Boston, Mass.," which shows the great neces- 



Plate 4. 




PREPARATION OF THE OPERATING-ROOM. 209 

sity of absolute cleanliness and liow easily infection 
takes place from dust in the room : 

"I was especially anxious to ascertain if any pus- 
producing organisms should be found in the dust. 

^' The operating-room is kept as clean as soap and 
water and corrosive sublimate can effect the cleanli- 
ness of its floor and walls. 

"The following is the report of B. A. Darling, 
Assistant in Bacteriology, Harvard Medical School : 




Fig. 176. — Petri dish with colonies (Warren). 

"Four Petri double dishes containing films of 
sterilized and coagulated blood-serum were exposed 
in various parts of the operating-room during a cel- 
iotomy, the period of exposure varying from one hour 
and twenty minutes to one hour and fifty minutes. 

"The plates were exposed during the middle of 
the forenoon of December 28, 1897. 

"One dish was placed on the floor, where we sup- 
posed the dust would be kept in the most active 
motion by our feet and the nurse's dress ; one was 
placed on the stand holding the sponge-pails; one 

14 



2IO SURGICAL TECHNIC. 

was placed on the patient's knees raised in the Tren- 
delenburg position ; and one was placed on the table 
beside the instrument-tray. The dishes were un- 
covered just as the knife went through the skin. 

"At the conclusion of the operation the dishes 
were covered, conveyed to the bacteriologic labora- 
tory, and placed in the incubator at 37° C. for several 
days. 

"After twenty-four to seventy-two hours the plates 
were opened and the colonies counted. 

"At the same time an attempt was made to de- 
termine the varieties of bacteria present, and par- 
ticularly to demonstrate the presence or absence of 
the pyogenic forms. 

"Cover-glass preparations and cultures were made 
from as many different kinds of colonies as could be 
distinguished. 

" The results are, in brief, as follows : 

"Plate A. Sponge-table^ exposed i hour 50 min- 
utes: after 24 hours showed 216 colonies; 72 hours, 
296 colonies. 

"Plate B. Knees of patient^ exposed i hour 20 
minutes : after 24 hours showed 156 colonies ; 72 
hours, 280 colonies. 

"Plate C. Floor ^ exposed i hour 50 minutes: 
after 24 hours showed 296 colonies; 72 hours, 428 
colonies. 

"Plate D. Instrument-table^ exposed i hour 40 
minutes: after 24 hours showed 216 colonies; 72 
hours, 256 colonies. 

"The varieties of bacteria present were studied 
minutely on Plate B (the one on the patient's knee), 
less carefully on Plate D (the one on the instrument- 



PREPARATION OF THE OPERATING-ROOM. 2! I 

tray). Of the recognized pyogenic cocci, two varie- 
ties were found — the Staphylococcus albus (15 colo- 
nies on Plate B, 20 colonies on Plate D) and the 
Staphylococcus aureus (3 colonies on Plate B, 4 colo- 
nies on Plate D). 

"The remaining colonies on both plates were sar- 
cinse of several kinds, yellow, orange, and white 
moulds, and several varieties of unrecognized bacilli 
and cocci. 

" As would be expected, the plate from the floor 
showed the largest number of colonies. Plate B (the 
one on the patient's knee) most interested me. 

"The finding by Dr. Darling of fifteen colonies of 
the Staphylococcus albus and three colonies of the 
Staphylococcus aureus on this small plate within a 
few inches of the opened abdominal cavity was cer- 
tainly a grand object-lesson, and has given lots of 
food for reflection.' ' 



CHAPTER XVII. 

TRANSPORTATION; PREPARATION OF PATIENT 
FOR OPERATION ; CARE OF PATIENT DURING 
AND AFTER OPERATION. 

Transportation. — The entire duty of attending to 
the transfer of a patient to or from home and hospital 
may fall upon the nurse. The following suggestions 
are made by Mr. Scully, who conducts a private am- 
bulance business in New York. The transportation 
of a patient, in order that it may be safely and pleas- 
antly accomplished, requires attention to detail. The 
nurse or friends of the patient should attend to the 
requirements for admittance by the hospital authori- 
ties, such as the hours of admission, financial details, 
and presentation of a written statement of diagnosis 
by the family physician. Other things being equal, 
it is better in the summer months to remove a patient 
early in the morning or toward evening; in the 
winter, near midday. Give as much notice as pos- 
sible in order to secure the best attention from the 
ambulance service. Have the patient ready at the 
hour arranged. Nothing is more trying to the patient 
than to be delayed, either by friends or by non-arrival 
of the ambulance. Do not disturb the patient by in- 
sisting on a perfect toilet; an ample supply of cover- 
ing is the chief necessity. The nurse should accom- 
pany the patient in the ambulance, to give any 

212 



PREPARATION OF FIELD OF OPERATION, 21 3 

needed attention and complete the arrangements with 
the hospital authorities. Jewelry and valuables should 
be checked at the hospital office. In transporting 
to and from railroads and steamships ample notice 
must be given to make connections. For all distances 
up to thirty-five miles, direct transportation by ambu- 
lance is preferable to train service, especially in cases 
of very sick patients. 

The methods given here for preparing the patient 
for abdominal operations may serve as a reliable 
guide to the nurse, who is more or less responsible 
for preparatory treatment. The methods of prepara- 
tion of all kinds are subject to change iu detail, 
because surgical methods are constantly advancing 
and changing, though the general principles remain. 
It should be remembered that patients rally much 
better from an operation when they have been 
properly prepared both externally and internally. 

Day Before Operation. — The patient receives a 
full bath and the hair is washed. A cathartic is 
given — castor oil, citrate of magnesium, or salts. 
The diet should be nourishing and light. Milk is not 
given before an abdominal operation, because the 
stomach may not digest it thoroughly, and its curds 
may remain in the intestines and act as an irritant. 
Gruel is nourishing and easily digested. No food is 
given after midnight. 

PREPARATION OF FIELD OF OPERATION. 

1. Scrub the parts with green soap and stiff brush. 

2. Shave from nipples to rectum. Chemical hair 
remover may be used; acts by dissolving the hair, 
but may prove too irritating to some skins. 



214 SURGICAL TECHNIC. 

3. Scrub again and rinse thoroughly with sterile 
water. 

4. Rub well with alcohol, followed with ether, to 
remove fats. 

5. Wash with corrosive sublimate (i : 1000), and put 
on an antiseptic dressing, consisting of five dressing- 
pads, one layer of common cotton, one dressing over 
that, then abdominal binder. The patient must be 
instructed not to put her fingers underneath, the 
dressing nor to disturb it in any way. 

Prepare the vaginal canal by giving a warm 
douche (lysol, i per cent.), and cover the vulva with 
a dressing. Use perineal straps to keep the dress- 
ing and abdominal binder in position. See that the 
dressings are kept wet with the antiseptic ordered 
imtil the patient is taken to the operating-room. 
This preparation should be made twelve hours before 
an operation. 

Some surgeons will direct the application of a 
poultice of greejt soap^ which is removed early on the 
morning of the operation, the part being scrubbed 
with hot water and a brush to remove the soap, a 
warm corrosive-sublimate poultice (i : 1000) being 
then applied. A green-soap poultice is a thin layer 
of green soap spread over a pad of gauze, absorbent 
cotton, or a towel, and covered with a dry towel and 
a bandage. The antiseptic pad, or the poultice, 
thoroughly softens the scarf-skin, which in about 
twelve hours can be scrubbed off, leaving the true 
skin. 



PREPARATION OF FIELD OF OPERATION. 215 



Biniodid of mercury is sometimes dissolved in 
the ether, making a sokition of i : 1000, which, be- 
sides removing all fatty substances from the skin, is 
also a disinfectant. When the skin is very dirty it is 
scrubbed with turpentine, then with 
alcohol, and then with the biniodid 
solution. The nose and mouth should 
be thoroughly sprayed with a satu- 
rated solution of boric acid every three 
hours. 





Fig. 177. — Solution basins stand. 




Fig. 17 



Day of Operation.— Flush out the colon and 
give a bath; take off all flannels, put on a gown open 
at the back, and cotton-flannel stockings. Cleanse 
teeth, mouth, nose, and throat with a boric-acid solu- 
tion and brush. Catheterize just before sending the 
patient to the anesthetizing-room if the operation is 



2l6 SURGICAL TECHNia 

on the uterus or its appendages. Always catheterize 
in other operations if the patient is unable to urinate. 
Envelop the hair in a sterilized towel. 

Remove all rings and ear-rings; also false teeth, 
whether a whole or a partial set, as there is danger 
of their being swallowed, and put them in a tumbler 
of cold water. Envelop feet and lower limbs in a 
warm blanket securely pinned around the hips with 
safety-pins. Besides preserving the heat, this ar- 
rangement will prevent the patient from tossing the 
limbs about while taking the anesthetic. Many 
operators give morphin (grain \) and atropin (yj^ 
of a grain), hypodermically, half an hour before 
the operation, to stimulate the heart and prevent 
vomiting. 

Arranging the Patient for the Operation. — 
The patient having been placed on the operating- 
table, the clothes are removed from the part to be 
operated upon, and sterilized blankets are tucked 
about the chest, the edges being tucked under the 
back to reduce as far as possible the loss of body- 
heat, and the bandage and pad are removed from 
the field of operation, which is again thoroughly 
cleansed with soap and water and disinfectants. An 
assistant nurse hands the sterilized water, green soap, 
and scrubbing-brush to the assistant surgeon. The 
soap-suds are rinsed off with sterile water, after which 
the part is sponged with permanganate of potassium, 
oxalic acid, lime-water, and sterile water, or with 
ether, alcohol, and bichlorid solution. This final 
scrubbing should be done in the anesthetizing-room 
if possible, while the patient is being anesthetized, 
to avoid delay in the operating-room. A sterilized 



ARRAXGIXG THE PATIENT. 21/ 

sheet, having an oval opening in the center throngh 
which the section is made, and towels are then 
arranged around the field of operation. One towel is 
laid along the side, turned over and fastened with 



Fig. 179. — ToAvels pinned over rubber-dam, leaving no skin surface exposed 

(Hirst). 

clamps to the sheet, so as to form a pocket in which 
the surgeon places the instruments he needs to have 
close at hand. The instruments are taken from the 
sterilizer and laid in trays containing sterile water or 
laid upon dry sterile towels. 

Some surgeons use the prepared sponges. These 
must be reliably counted before the operation by the 
operator and assistants, and the number written down, 
so as not to trust to memory. Sponges must be 
squeezed almost dry before they are handed to the 
surgeon, because it is only in an almost dry condition 
that they are of service. The nurse should not, 
while waiting to hand a fresh sponge, rest her hands 



2l8 



SURGICAL TECHNIC. 



or forearms on the pail. She should count the 
sponges before the surgeon begins to sew up the 
wound, and then should be very sure that she has the 
exact number employed in the operation. The large 




square sponges used for covering the intestines, or 
walling off small areas, should have a long piece of 
silk attached, and to this a forceps, so that if one 
should slip out of sight it can be readily located and 
recovered without undue handling of the bowel. 
After being used, the sponges are put into a pan or 
basin, and should not be disposed of until they have 
been accounted for before the abdomen is closed. 

Whatever has been removed from the body must be 
placed in a basin and laid aside in a safe place until 
the surgeon gives his directions as to whether or not 
he wishes it to be sent to the laboratory for examina- 
tion to make sure of its character, with a view to 
clearing up some obscure point about the nature of 
the disease. 



ARRANGING THE PATIENT. 2ig 

The head-nurse attends to the instruments, sutures, 
and ligatures. If the dry technic is used, a basin 
of dry gauze sponges is placed on a table within easy 
reach of the operator's assistants. 

The assistant nurses must be on the alert to change 
the hand solutions when necessary, and to wipe the 
moisture from the face of the operator and his assistant 
with a sterilized towel, to prevent drops falling 
into the wound, and this must be done at a moment 
when the surgeons are not bending over the wound. 
They must move about the room very quietly but 
quickly. If asked to do anything that they do not 
understand, they should always inform the head nurse, 
who will make the duty clear. When emergencies 
arise and the operator is dealing with exceptional 
difficulties, the nurses must be on the alert to do 
quickly anything they may be called upon to do, 
each nurse discharging her duties without under- 
taking those belonging to another. It is absolutely 
necessary on such occasions to exercise self-control, 
and to follow the directions given without excitement 
or confusion. 

Just before the wound is closed the soiled towels 
are removed and replaced by fresh ones. After the 
dressing has been applied the patient is raised, wiped 
perfectly dry, and a bandage put on. While the 
patient is waiting to be transferred to bed, hot- 
water bottles, well covered, should be applied to all 
parts of the body. The blankets used to cover the 
feet and chest of the patient during the operation 
should be tucked closely about the body and under- 
neath, and not merely be thrown over. 

Pneumonia and pleurisy after operation may follow 
as the result of chilling when in the operating- 



220 SURGICAL TECHNIC. 

room, or exposure during the removal from tlie oper- 
ating-room to the patient's room. 

When the patient is replaced in bed, which has 
been thoroughly warmed during the operation, the 
nurse should be present to take charge. The pillow 
should be removed, and a towel placed for the head 
to rest upon. The foot of the bed is elevated, this 
posture being maintained for tv/enty-four hours, after 
which the bed is lowered. The heaters are placed 
about the patient's body, one thing being kept con- 
stantly in mind — not to burn the patient. A towel 
should be placed under the chin of the patient, and 
a small basin should be at hand to receive the vomited 
mucus, and this should be removed during quiet 
intervals. Nausea and vomiting may be relieved 
by saturating a towel with fresh, strong vinegar 
and holding it a few inches from the patient's 
face, laying it over the nostrils, or hanging it from 
the bedstead so that it will be near the patient's 
head. Oxygen hastens the recovery of consciousness 
and lessens the nausea. If administered with the 
anesthetic, there is almost complete absence of nau- 
sea — usually none as soon as the patient is fully con- 
scious. 

Dryness of the mouth and lips, and thirst (which 
is often a troublesome feature), may be relieved by 
placing wet cloths on the lips, by allowing the patient 
to rinse out the mouth with cool water, and by fre- 
quent bathing of the hands and face with alcohol and 
tepid water or with plain water. If thirst is extreme, 
an enema of saline solution (one pint) is given 
slowly. 

The patient should not be left alone for a single 



BLADDER AND BOWELS. 221 

moment during the first thirty-six hours after an ab- 
dominal section if it can be avoided. The patient 
can do nothing for herself, and every want should be 
instantly supplied. I have known patients so eager to 
allay their thirst that they would get out of bed and 
drink water from the water-pitcher on the wash-stand 
and reach down for the hot-water bottle at the feet and 
drink part of the contents. One ward patient drank the 
water from an irrigator standing by the side of the 
next bed ; another patient while in a semiconscious con- 
dition took the drainage-tube out of the abdomen, and 
when found by the nurse after a moment's absence 
from the room was sitting up on the edge of the bed. 
Watching a patient recover from anesthesia is often 
monotonous; but if this duty is closely attended to, 
many dreadful accidents will be avoided. 

A roll should be placed under the knees, so as to 
relax the abdominal muscles and also to remove the 
strain the patient would have to make in order to 
keep up the knees. A small flat pillow placed under 
the hollow of the back will relieve the backache of 
which so many patients complain. 

Bladder and Bowels.— The catheter should be 
passed every six or eight hours if necessary, accord- 
ing to directions, the most rigid aseptic precautions 
being taken. Flatulence may be very distressing; 
consequently passage of gas by the rectum is of good 
omen, as it shows that the bowels have regained their 
normal tone and there is no obstruction. After an ab- 
dominal operation the muscular walls of the intes- 
tines share in the weakness of the patient, and are 
not strong enough to overcome the contraction of the 
sphincter muscle. The accumulation of gas distends 



222 SURGICAL TECH NIC, 

the muscular fiber of the intestines, and, if not re- 
lieved, would soon result in paralysis of the intes- 
tines. To prevent this a rectal tube is inserted to 
keep the sphincter dilated and to allow the gas to 
escape when it reaches that point. Purgatives, such 
as calomel (grain i every hour until lo grains have 
been taken), are usually given as soon as possible 
after the patient has recovered from the anesthetic, 
to stimulate the intestines, and keep up peristaltic 
action. 

Much fluid is not given for a certain number of 
hours after the operation, as it might cause vomit- 
ing, and also because, as we have seen, bacteria 
require heat and moisture for their development. 
If they can lie in a small pool of fluid, they will de- 
velop rapidly. We cannot deprive them of warmth 
unless we almost freeze the patient, but we can 
deprive them of moisture. Should any bacteria 
have found their way during the operation into the 
abdominal cavity, they will be rendered inert by 
the absence of moisture, and will be taken by the 
leukocytes into the lymphatic vessels and glands and 
be devoured. 

After twelve hours, if there is no vomiting, very 
hot water, or toast-water is given in teaspoonful 
doses every fifteen or twenty minutes, the quantity 
being gradually increased and the intervals length- 
ened. The familiar cup of freshly made tea is some- 
times the best drink to begin with; it is always a 
pleasure under the circumstances to see the patient 
enjoy it, since it is not only refreshing but stimu- 
lating. If the stomach behaves well, tablespoonful 
doses of gruel or beef-essence may be given every 



BLADDER AND BOWELS. 223 

half hour. Milk is not given as a rule, as the curd 
may pass along the intestines and act as an irritant. 
For the first three days, and if there is no vomiting, 
nothing but liquids is given ; and after the third day 
soft and easily digestible food, which is gradually 
changed to a more solid diet. 

The external genitals should be kept perfectly 
clean, the body bathed, the bed and body-linen kept 
sweet and clean, the teeth brushed, and the hair 
combed. Every want of the patient should be an- 
ticipated, and she should be made as comfortable as 
possible. Sponging the palms of the hands, the 
arms, and the legs will add to the comfort of the 
patient. The luxury of a change into a fresh bed 
will often secure a good night's rest. Under no con- 
sideration should morphin be given except by the 
surgeon's directions, and every moral influence should 
be exerted to induce the patient to endure pain rather 
than resort to the drug. 

The nurse should not ascertain whether the patient 
is comfortable by continual questioning, but by unob- 
trusive observation. Questioning may alarm a patient 
and lead her to think too much about herself. 

No visitors should be admitted without the sur- 
geon's consent. The mind of the patient is to be 
kept perfectly free from worry and excitement, and 
the whole atmosphere of the room should be bright, 
pleasant, and cheerful, no matter what trouble is 
going on outside. 

A slight rise of temperature the day following oper- 
ation usually marks reaction from shock. On the 
eighth day the dressings are removed and the stitches 
taken out. The following week the patient sits up, 
and at the end of the third week she goes home. 



224 SURGICAL TECHNIC. 

The following diet- list, dating from the third day, 
will be of assistance in varying the food. 

First Day. 
Breakfast. — Mutton-broth with bread-crumbs. 
Lu7tch. — Milk-punch. 

Dinner. — Raw oysters, thin bread (with crust re- 
moved) and butter, sherry wine. 
Ltmch. — Cup of hot beef-tea. 
Supper. — Milk- toast, jelly. 

Second Day. 

Breakfast. — Oatmeal with sugar and cream, cup 
of cocoa. 

Lunch. — Soft custard. 

Din7ier. — Small piece of tenderloin steak, chewed 
but not swallowed, baked potato. 

Lunch. — Glass of milk. 

Supper. — Buttered milk-toast (crust removed), 
jelly, cocoa. 

Third Day. 

Breakfast. — Soft-boiled ^<g^.^ bread and butter, 
coffee. 

Lunch. — Milk-punch. 

Dmner. — Chicken-soup, * tender sweetbreads, Ba- 
varian cream, light wine. 

Lunch. — An egg-nog. 

Supper. — Tea, raw oysters, bread and butter. 

Fourth Day. 

Breakfast. — Oatmeal with sugar and cream, a ten- 
der sweetbread, creamed potatoes, coffee, graham 
bread and butter. 

Lunch, — Glass of milk. 



DIET- LIST. 225 

Dt7tner. — Chicken panada, baked potato, bread, 
tapioca-cream. 

Lii7ich. — Cup of hot chicken-broth. 

Supper. — Buttered dry toast (crust removed), wine 
jelly, banquet crackers, tea. 

Fifth Day. 

Breakfast. — An orange, scrambled ^%%^ oatmeal 
with sugar and cream, soft buttered toast, coffee. 

Lunch. — Milk-punch. 

Dinner. — Cream of celery soup, a small piece of 
tenderloin steak, baked potato, snow pudding, wine, 
bread. 

Lunch. — An egg-nog. 

Supper. — Calf's foot jelly, soft-boiled ^'g'g^ bread 
and butter, cocoa. 



Sixth Day. 

Breakfast. — Oatmeal, poached eggs on toast, coffee. 

Lunch. — Cup of chicken-broth. 

Dinjier. — Chicken-soup, small slice of tender roast 
beef, baked potato, rice-pudding, bread. 

Lunch. — Glass of milk. 

Supper. — Baked apples, raw oysters, bread and 
butter, orange-jelly, tea. 

Seventh Day. 

Breakfast.— OxdingQ^ mush and milk, scrambled 
eggs, cream-toast, coffee. 

Lunch. — Cup of soft custard. 

Dinner. — Mutton-soup, small piece of tender beef- 
steak, creamed potatoes, sago-pudding, bread, wine. 

15 



226 



SURGICAL TECHNIC, 



Lunch. — Cup of beef-tea. 

Slipper. — Sponge-cake with cream, buttered dry 
toast, wine-jelly, cocoa. 

Eighth Day. 

Breakfast. — Broiled fresh fish, oatmeal, graham 
bread, coffee. 

Lunch. — Chicken-broth. 

Dinner. — Potato-soup, breast of roasted chicken, 
mashed potatoes, macaroni, blanc mange. 

Lunch. — Cup of mulled wine. 

Supper. — Cream-toast, lemon-jelly, chocolate. 




Fig. i8i, — Griffith's bed-grapple for patient's comfort during convalescence. 

The diet for other days may be selected from pre- 
vious ones. The change of diet may cause a tem- 
porary rise in the temperature and pulse. 



CHAPTER XVIII. 

SEQUELS OF OPERATIONS; SHOCK, HEMOR. 
RHAGE, SEPTIC PERITONITIS, ACCIDENTS 
DURING OPERATION, ETC. 

As a rule, the average abdominal case passes into 
convalescence, especially when the case is in skilled 
hands and the operation has been performed in a 
finished surgical way. Complications, however, are 
liable to arise in the simplest case, and throw great 
responsibility on both surgeon and nurse. It is in 
these cases that the knowledge and skill of the nurse 
mean so much, and where the greatest triumphs of 
surgery are scored. 

A nurse has no moral right to take charge of a 
surgical case unless she has at her finger-ends the 
complications liable to arise, their symptoms and the 
various means of meeting them until the arrival of 
the surgeon. 

Shock is great depression of the vital functions 
of the body brought on by injury or surgical opera- 
tion. It is produced through the agency of the ner- 
vous system. The greater the injury, the longer the 
anesthesia, the greater the shock. The anesthetic 
enables the patient to undergo the operation without 
consciousness, but it does not prevent shock coming 
on afterward from the opening of the abdomen, the 
uncovering of the viscera, the handling of the intes- 
tines, and the exposure of the delicate sympathetic 

227 



228 SURGICAL TECHNIC. 

nerves in that part to the air and to touch. If to all 
this is added a long anesthesia, then the prostration 
produced by the anesthetic is added to the effects of 
the operation. 

Different individuals are differently affected: most 
persons are more susceptible to shock after months 
of hard work, or when the system is run down after 
an illness. Invalids stand shock very well, and in- 
different persons stand it better than those who are 
despondent. The mental influence is very great: 
anything that depresses the mind aggravates shock. 
It is here that the offices of the Church have such 
an effect on sonie patients, in quieting apprehension 
and in adding fortitude. 

Age modifies shock. In old people shock is 
usually more severe and prolonged, especially if 
there is any organic disease. Children recover 
readily from shock if there has been very little loss 
of blood. Shock is combated to a certain extent by 
the patient's drinking a large amount of fluid for 
forty-eight hours before the operation, so that the 
blood-vessels of the vital organs will be well supplied 
with fluid during the operation. Experiments have 
been made which show that when the abdomen is 
opened the abdominal veins dilate, and as a conse- 
quence a large amount of the blood in the body flows 
into them, thus leaving the heart and the vessels con- 
veying blood to the important nerve-centers at the 
base of the brain with very little fluid to work upon, 
and shock ensues. The output of the heart, as we 
know, is in proportion to the venous pressure, and 
if this is lowered the heart and the important nerve- 
centers at the base of the brain will be supplied 



SHOCK. 229 

with a diminislied amount of blood. The intra- 
venous injection of saline solution causes a rise in 
the venous pressure and an increase in the output of 
the heart. The signs of shock may be and have been 
mistaken for those of hemorrhage on account of the 
two presenting so many points of likeness ; but in 
shock the symptoms are present from the first, while 
in hemorrhage they do not come on for some hours 
after the operation. 

Two very important points to be considered in case 
of shock or of hemorrhage are the temperature and 
the condition of the patient's mind. In shock the 
temperature at first is normal or very little below nor- 
mal, and the senses are dull in proportion to the degree 
of shock present; in hemorrhage the temperature is 
subnormal, the mind is bright, keen, and alert, and 
there is an anxious expression on the face, as if the 
patient were anticipating danger. 

The sy77ipto}ns of shock are a weak, rapid, and ir- 
regular pulse; sighing, rapid, irregular, and shallow 
respiration; a normal or slightly subnormal tem- 
perature ; a pale face with a pinched look ; a cold, 
clammy skin, and dulness of the mind. There 
may be involuntary movements of the bowels and 
urine as a result of loss of muscular power ; nausea 
and vomiting may also be present. 

The treaUneiit of shock consists in lowering the 
patient's head and raising the foot of the bed, to in- 
crease the supply of blood to the vital centers ; in 
the application of heat to all parts of the body, 
particularly the sides, between the legs, and to the 
feet; in placing a mustard-plaster over the heart; 
in administering whiskey, brandy, or nitroglycerin 



230 SURGICAL TECH NIC. 

hypodermically; in giving hot black coflfee by the 
rectum, or saline solution hypodermically or by 
the rectum. Strychnin is a powerful stimulant, and 
should be given in doses of 2V grain every half hour 
for four doses. Tincture of digitalis in 15-minim 
doses may be given every half hour for four doses. 
As a rule, in cases of shock there is a disposition 
on the part of nurses to do too much. Everything 
must be done in a prompt, quiet manner. For imme- 
diate stimulation in threatened collapse nitroglycerin 
is valuable. It is used for quick effect only, and 
not for prolonged stimulation of the heart's action. 
Stimulants must be given carefully, and time 
allowed to observe the effects produced, other meas- 
ures being determined accordingly. An enema of 
one-half ounce of turpentine, a well-beaten raw ^%g^ 
and three ounces of warm water constitutes a power- 
ful stimulant. 

It must be remembered that in severe shock the 
function of absorption by the stomach and intestines 
is almost wholly suspended, and anything given by 
the rectum must be introduced high up. When the res- 
piration of the patient is fast failing, everything de- 
pends on maintaining the heart's action. To this 
end artificial respiration must be persistently prac- 
tised. A serious danger in performing artificial res- 
piration is that in our hurry we may make the 
motions too rapidly and not give the lungs time to 
fill thoroughly nor allow the air to be expelled before 
filling the lungs again. The motions should not be 
more frequent than sixteen to eighteen in the min- 
ute, so as to imitate as nearly as possible the nat- 
ural rhythm of respiration. External heat is a most 



SHOCK. 



23 



powerful heart-stimulant, and often when the heart's 
action fails it may be restored by heat over the heart 
and bv hot fluids taken into the stomach. 




Fig. 182. — Sylvester's method of performing artificial respiration (inspiration). 

Recovery may be rapid or very slow ; it is mani- 
fested by "reaction" — the pulse becomes more full, 




Fig. 183. — Sylvester's method of performing artificial respiration (expiration). 

slow, and regular, the temperature rises, the body 
becomes warm, and a general improvement takes 



232 SURGICAL TECHNIC. 

place. In rare cases the reaction becomes excessive 
and develops into traumatic delirium^ which may be 
mild, low, and muttering, or of the wildest character. 
The skin is hot and flushed, the pulse full and regu- 
lar, and the temperature above normal. This condi- 
tion may subside and recovery take place, or it may 
be followed by collapse. 

Hemorrhagic may be caused by the slipping of a 
ligature or by the displacement of clots, as the result 
of restlessness or reaction of the circulation, and 
generally occurs within the first twenty-four hours 




Fig. 184.— Esmarch's tourniquet, consisting of 9 feet of elastic webbing 
2>^ inches wide, 3 feet tubular strap with chain. 

after the operation. The hemorrhage which comes 
from torn adhesions and bleeding surfaces is a 
free oozing, and seldom affects the pulse. When a 
drainage-tube has been used, it will usually indicate 
that there is hemorrhage by a flow of blood 
through the tube. This, however, cannot be relied 
upon, as only a moderate quantity of blood may 
flow through the tube, the abdomen being filled 
with clots. 



HEMORRHAGE. 



233 



The symptoms of internal hemorrhage are restless- 
ness, thirst, faintness, an anxious expression, pale 
face, dilated pupils, cold skin, frequent and irregular 




Fig. 185. — Bellocq's canula, used for passing a cord through the nose, 
to be drawn out of the mouth, and gauze or cotton plugs attached for packing 
the nasal cavity for hemorrhage. 

or sighing respiration, subnormal temperature, and a 
weak, rapid pulse (120-140). In rare cases the pulse 
is not greatly accelerated. 

Treatment. — The patient must be kept perfectly 
quiet on her back, the head being lowered and the 
foot of the bed elevated. If symptoms of shock 
supervene, heat is to be applied to all parts of the 
body by warm blankets and hot-water bottles. 
Stimulants are given only when the pulse is failing, 
as they excite the heart's action and increase the 
hemorrhage. When the hem^orrhage has been exces- 
sive, infusion of saline solution is resorted to, the 
fluid that the body has lost being thus replaced. 
Bandaging the limbs from their extremities upward 
is sometimes of use in keeping the blood in the vital 
organs. When the hemorrhage comes from a slipped 
ligature with large vessels pouring blood into the 
abdominal cavity, the abdomen is reopened and the 
vessel ligated. Everything should be ready for 
operative interference when the surgeon arrives, the 
same aseptic precautions being observed as in the 
original operation. For the free oozing from torn 



234 SURGICAL TECHNIC. 

adhesions the tube is emptied frequently — every ten 
minutes. The drier the pelvic cavity is kept, the 
sooner will the hemorrhage cease. 

A noted surgeon has said that if an abdominal case 
escapes vshock or hemorrhage, there is still a third 
danger to which the patient is liable, that of septic 
peritonitis. This is due to the entrance of germs 
into the peritoneal cavity, either from without or 
from ruptured abscesses or wounds. It may set in 
at any time from a few hours to six days after ope- 
ration. The symptoms are pain in the abdomen and 
exquisite tenderness, distention, vomiting, constipa- 
tion, icterus, restlessness, sleeplessness. 

The temperature rises a little, rarely going for a 
few days above ioo° or ioi° F. ; but the pulse creeps 
up rapidly to 115, 120, or 130 beats per minute, and 
is weak and thready; although sometimes it is hard 
and "wiry" in the beginning. Then the temper- 
ature rises to 103° F. or above. The rectal or vag- 
inal temperature may show a much higher rise than 
that of the mouth or axilla. In one typical instance 
the temperature taken in the mouth ranged between 
101° and 102° F., the skin was cold and clammy, 
and the patient complained of intense thirst and a 
''burning up" feeling. The vaginal temperature 
was 108° F. In some of the worst cases the writer 
has seen the temperature was below normal, but the 
prostration was severe. The abdomen is distended, 
due to distention of the transverse colon by gas. 
There are nausea and vomiting. First the contents of 
the stomach are vomited, then bile, then a dark coffee- 
colored fluid which becomes more and more fecal in 
odor; a cold perspiration appears; the patient has a 



HEMORRHA GE. 235 

very anxious, pinched expression, and is restless and 
talkative; the eyes are unusually bright, and there is 
a faint yellowish look about the skin and conjunc- 
tivae. As the disease continues the general system 
becomes poisoned. 

The treat7ne7tt consists in ridding the system of 
the poison through the skin, bowels, and kidneys. 
High enemata of turpentine, glycerin, oil, salts, or 
molasses are usually given until the bowels are 
thoroughly moved or large quantities of gas are 
passed, because it is by putting the bowels into an 
active state that the threatened paralysis of the intes- 
tines can be overcome, and they can take up from 
the peritoneal cavity the poisonous materials that 
are causing the disturbance. It is only when the 
intestines are so paralyzed that they cannot be moved 
that a fatal result ensues. Strychnin, being a power- 
ful heart-stimulant, is given in doses of grain -^ 
every hour until its physiologic effects are pro- 
duced. It must be stopped at the first appear- 
ance of twitching of the muscles of the face or 
of the limbs and stiffness of the neck. Vomiting 
may be relieved by washing out the stomach, by 
the application of a mustard-plaster over the region 
of the stomach, or by cocain in ^-grain doses for 
four doses. If improvement does not follow, the 
surface of the body becomes cold and clammy; the 
face pinched and sunken and of a dusky hue ; the 
restlessness increases, also the thirst, which becomes 
very great, and to the last the patient calls for water, 
which is vomited immediately after being taken, but 
which it is cruel to withhold. The mind usually 
remains clear to the end. 



236 SURGICAL TECBNIC. 

Antistreptococcic serum has been used with fairly 
good results. It comes in glass tubes, sealed her- 
metically, and is injected hypodermically with an- 
tiseptic precautions into the thigh or the side of the 
breast, where there is considerable loose subcuta- 
neous connective tissue. Another procedure of value 
is infusion of normal saline solution for the purpose 
of diluting the toxins in the blood and of removing 
them by the increased flow of urine which infusion 
brings about. 

Tympanites is often one of the earliest signs of 
septicemia, and when accompanied with a high tem- 
perature is usually a cause for anxiety, though it may 
be due to constipation, and in such cases is usually 
without significance. The treatment consists in the 
application of turpentine stupes, the use of brisk 
purgatives or high enemata, and the insertion of the 
rectal tube for about ten inches. 

Fermentation-fever is due to the absorption of 
fibrin-ferment and the products of aseptic tissue- 
necrosis. It causes a slight rise in temperature 
which need occasion no anxiety. 

Intestinal obstruction may be due to strangula- 
tion of a knuckle of intestine beneath inflammatory 
bands, or to its enclosure between the sutures in the 
wound. There is usually distention of the abdomen. 
Note should always be made if gas is heard rumbling 
in the intestines, and also if gas is passed and how 
often ; also the result of the enemata which are ad- 
ministered to relieve the distention. 

Hernia is a sequel rather than a complication of 
abdominal operations, and is due to a failure of union 
between the cut edges of the muscles and fasciae. 



SINUS. 



237 



As a rule, it does not occur until some weeks after 
the patient has returned home. It is to prevent this 
accident that such stress is laid upon not allowing 
the patients to help themselves in any 
way without the surgeon's permission, 
so that the abdominal muscles may have 
sufficient time to become firmly united. 
This is also the reason why patients 




Fig. 186. — General operating table. 

should wear an abdominal supporter for some months 
after their discharge. If hernia occurs, it is usually 
treated by a secondary operation. 

A sinus is often caused by imperfectly sterilized lig- 
atures, which may cause an abscess around the point 
of ligation. This abscess may discharge itself into 
the intestine or vagina, or into the tract occupied by 
the drainage-tube through the abdominal wall. The 
sinus keeps open until the ligature is discharged or 
removed by another operation. 



238 SURGICAL TECHNia 

Accidents during Operation.— Many times in 
difficult abdominal or vaginal operations the walls of 
the bladder may be torn, or one of the ureters or the 
intestine may be injured. When the ureter or blad- 
der is injured, the urine sometimes passes through the 
incision to the dressing. This is called a urinary 
fistula. When the intestines are injured, fecal matter 
is discharged through the wound. This is a fecal fistula. 

Vaginal hysterectomy is the most serious of vagi- 
nal operations, but the nursing is the same as every 
operative case requires. If clamps are used, they 
usually remain attached for forty-eight hours. The 
handles are usually supported on a pad of absorbent 
cotton. In the handling of the clamps great care 
must be used, as, for instance, when the patient is 
lifted on the bed-pan one nurse should lift the clamps. 

Hysterectomy is the complete removal of the 
uterus and ovaries, either through the vagina (vagi- 
nal hysterectomy) or through the abdomen. Regard- 
ing the question of insanity which may follow a hys- 
terectomy or the removal of a large fibroid tumor, 
one must know that a large amount of blood is 
taken from the body ; that the cutting and tying of 
the large blood-vessels alter the circulation ; and that 
the operation is also more or less a shock to the 
nervous system, and may affect the brain. Insanity 
is not a complication of this operation, the recovery 
from which is usually rapid ; but when insanity does 
set in, this is commonly the cause, and the patient 
generally recovers. 



CHAPTER XIX. 
SPECIAL OPERATIONS. 

Operations Upon the Head. — Nursing after opera- 
tions upon the brain calls for special diligence in 
watching the patient during the first hours subse- 
quently. Unlooked for symptoms may arise, and a 
change for better or worse in those accompanying the 
condition for which operation was performed; delir- 
ium, acute mania, or paralysis of some part or of the 
half of the body may develop, or, having been present, 
become rapidly altered in degree and aspect. Care to 
prevent the patient from injuring himself, falling from 
the bed or disturbing the dressing and doing direct 
injury after a trephining is necessary. Especially 
should the nurse be on her guard to prevent such 
patients being burned by hot-water bottles. Head 
operations being often long ones, or done for acute 
conditions in which the degree of shock is marked, 
the efforts to revive can easily be overdone in the 
matter of temperature of the hot-water bag with a 
subsequent further complication of the case from a bad 
body burn. As a general rule, it is safest to never put 
a bag directly against the patient's body, but to place 
it outside the blanket. 

Eye^ ear^ nose^ and throat cases, besides the general 
care and watchfulness necessary, require to be ob- 
served for shock or hemorrhage, where, as in the case 

239 



240 



SURGICAL TECHNIC. 



of the eye, serious functional injury might be done; 
or special symptoms complained of relating to the 
particular sense-organ operated upon. 




Fig. 187. — Soft-rubber nasal and 
ear syringe. 




Fig. 188. — Syringe cup to 
hang upon patient's ear to 
catch the drip when irriga- 
ting the aural canal. 



Operations upon the neck generally require the 
patient to assume the supine position. The chief 
danger is from accidental postoperative secondary 
hemorrhage, and this contingency may occur up to 
the third or fourth day when due to slipped ligatures. 
After intubation and tracheotomy operations, the 
nurse must be watchful lest the tube becomes dis- 
placed, coughed out, or clogged by exudate or false 
membrane shreds. Rapid cyanosis or a blowing- 
bellows action sounding through the tracheal slit are 
the sioriis call inor for immediate correction of the diffi- 
culty, to avoid an immediate fatal termination of the 
case from total closure of wound or tube. If the case 
is one of tracheotomy with a displaced tube, the nurse 



SPECIAL OPERATIONS. 24 1 

should make no attempt at readjustment, but quickly 
loosening or cutting the tapes, must, after withdrav/ing 
the tube, insert and set the tracheal forceps, which in- 
strument must be ever at hand at the patient's bed- 
side for such emergency use. Afterward the surgeon 
may be sought, who will replace the tube; but there 
will not be time to send for the physician to perform 
the former vital office. 

Operations upon the thorax include those open- 
ing the chest for draining the pleural cavity and the 
mediastinum, suturing the heart, as after a stab or 
gunshot wound, removal of tumors within or upon the 
chest-walls. Shock and hemorrhage must be particu- 
larly watched for. Besides, in operations involving 
the pleura, collapse of the lung from disturbance of the 
internal chest, vacuum may occur, calling for a prompt 
treatment of the associated rapid sinking and cyanotic 
state generally accompanying it, depending upon the 
physical state of the organ. Efforts tending to a re- 
establishment of the normal state of vacuum carried 
out by the surgeon includes the attempt at production 
of artificial vacuum by means of an air-pump or by 
use of the Bier apparatus, consisting of a pump and 
having a bell-glass connection. The nurse's efforts 
in face of such complication would include the careful 
but rapid withdrawal of the drainage-tube, if there be 
any, and the sealing of the opening in the chest-wall 
by means of rubber tissue and adhesive-plaster strips, 
or by use of a plug of sterile cotton, held in place by 
adhesive straps. 

Abdominal operations must also be observed for 
the first signs of a developing general peritonitis. 

In the extremities, after operation for pus infec- 

16 



242 SURGICAL TECHNIC. 

tion, elevation of the parts so affected goes far to pre- 
vent the lymph stasis or blocking up of the lymph 
spaces, with consequent squeezing, too, of the arterial 
and venous capillaries, thus aiding pus development; 
whereas, if free circulation is permitted, even at the 
cost of increasing pressure from elevation, recovery is 
aided. Further benefit in this connection is obtain- 
able by the frequent applications of water as hot as 
can be borne. Finally, where the nurse applies the 
gauze and bandages, she must remember and use the 
minimum amount, else, in thus putting germs to bed 
in her bulky dressings, she assists in retaining heat at 
the surface wound of a temperature at which they de- 
velop quickest. 

Fractures, whether the patient be confined to bed 
or not, always require the most careful attention from 
the nurse in charge. A slight displacement following 
a misstep in going about the wards, if unreported and 
not looked after, may decide the future functional value 
of a fractured arm. But if the danger is so great, why 
not keep all fracture cases in bed? For the reason 
that most patients, even fractures of the thigh, when 
a proper sustaining splint can be applied, improve 
more rapidly when they are up and about, a bed being 
oftentimes too sedative in effect for the patient's best 
interest. 



CHAPTER XX. 
OPERATIONS IN PRIVATE PRACTICE. 

In private practice the preparation of the patient is 
just the same and should be carried out as thor- 
oughly as in a hospital. If it is not possible within 
twenty-four or thirty-six hours to make the prepa- 
ration, then we cannot say that our attempts to 
obtain asepsis approach perfection. In emergency 
cases when there is not sufficient time to permit a 
thorough cleansing, freedom from sepsis is not so 
certain, and these cases do not cause the same anxiety 
as those that are sent to a hospital, where every effort 
to obtain complete asepsis is made. We must remem- 
ber, in making the preparations, to make as little 
bustle and noise as possible, and to carry on the 
preparations in a quiet and cheerful manner, so as not 
to frighten the patient and family. When the sur- 
geon and his assistants arrive they must be shown 
to a room in which they can change their clothing. 
The patient is not anesthetized until everything is 
in readiness. 

One difficulty which a nurse will have to encounter 
in private practice is likely to trouble her a great deal, 
inasmuch as she will find surgeons who conduct de- 
tails of cases in a way to which she is not accus- 
tomed, and which may appear to her wrong, and 
which indeed may very often be crude and unscien- 

243 



244 



SURGICAL TECHNIC. 



tific. In these cases she should not be too ready to 
show her superior wisdom and instruct the surgeon, 
and inform him under whom she received her train- 
ing, because there is not the slightest likelihood that 
he will act upon her suggestions, but will naturally 
be offended. 




Fig. 189. — Portable operating-table set up for a vaginal operation (Hirst). 

The directions for preparing for the operation 
will be given by the surgeon in charge. Have the 
temperature at about 75° F. In some houses 
there may . be a separate room for the operation, 
while in others the nurse will have to prepare 
the patient's bedroom. In the latter case the bright- 



OPERATIONS IN PRIVATE PRACTICE. 245 

est end of the room must be selected for the 
operation, to afford the surgeons plenty of light. x\ 
screen must be put up before the bed, so that the 
patient will not see the preparations. The nurse 
should remove from the room all movable furniture; 
sheet any large piece, as piano; lay oilcloths or news- 
papers covered with a damp sheet on the carpet, and 
pin them securely to it, and fasten a curtain across 
the window, so that the operation cannot be viewed 
from the opposite side of the street; or the panes may 
be frosted by lathering with soapsuds or sapolio. 
The remaining furniture and window-frames should 
be washed with carbolic-acid solution (i : 60), and on 
the morning of the operation should be mopped with 
a cloth wrung out of the solution. The articles nec- 
essary for the operation can be placed on the operating- 
table, covered with a sterile sheet, and be left outside 
the room until the patient is partly etherized, when 
they may be carried in. 

Have ever>^thing ready the night before, when pos- 
sible. If a separate room can be had, one with a 
northern light is to be preferred; and if possible it 
should be near the bath-room and convalescent 
chamber. Fill the bath-tub half full with i : 1000 
bichlorid solution for washing pitchers, plates, wash- 
bowls. Unless the nurse has twent}--four hours' 
notice in which to prepare the room for operation, it 
should not be disturbed, because if swept and dusted 
immediately before the operation dust is stirred up 
and the air is so filled with germs that it would not 
be safe to open the abdomen in the room. If the 
nurse has a few days in which to prepare for the 
operation, all unnecessary furniture should be re- 



246 



SURGICAL TECH NIC, 



moved, the hangings taken down, the room thor- 
oughly swept, and the walls and remaining furniture 
washed with carbolic-acid solution (i : 60) and ex- 
posed to the action of the sun and air for about 
twelve hours, when the v/indows are to be closed. 




Fig. 190. — Bed arranged for reception of patient : A trough is made under 
the blanket by hot-water bags on either side. A towel is pinned to the 
lower blanket under the patient's head (Hirst). 

the room thoroughly dusted with a damp cloth, and 
not again disturbed. The kitcJie7i^ if not too remote, 
makes the best operating-room; it is warm, hot and 
cold water are close at hand, and there is no danger 
of soiling carpets or hangings. Plug the drain-pipe 
openings with gauze or towel-pads soaked with bi- 
chlorid solution i : 1000. 

When the operation must be performed in the 
patient's bedroom, push the bed up in one corner. 

A word regarding the bed. If possible, it should 



OPERATIONS LV PRIVATE PRACTICE. 



247 



be an iron bedstead with a fresli horsehair mattress 
and pillow. The tall wooden bedsteads which we 
so often find are perhaps heirlooms which have wit- 




FlG. 191- Kitchen table prepared for gynecologic operation, showing Kelly 
draining-pad and leg supports (Hirst). 

nessed every illness that has visited the family, and 
also the deaths. They cannot be disinfected so 
thoroughly as can iron bedsteads. 



248 SURGICAL 'tECHNIC. 

The operating-table should not be wider than 
twenty-five inches nor higher than thirty-seven 
inches, because if low and wide the surgeon will 
have to stoop and bend forward. A kitchen-table, or 
a dining-room table with the leaves hanging, and a 
small table at one end for the patient's head, or two 
dressing-tables, one placed across the head of the 
other, will make a good narrow operating-table; or 
three chairs, with two planks ; a leaf from an exten- 



I'' 



\kj' 



Fig. 192. — The Trendelenburg posture in bed, using a chair to elevate 
the pelvis (^De Lee). 

sion-table, or an ironing-board laid across them, may 
suffice. 

A word of caution here: the nurse should not use 
any old blanket or comforter to cover the operating- 
table, for it is likely to be filled with germs. The 
top cover may be rubber bedcloth, oilcloth, or folded 
sheet, tied to the table by means of a muslin bandage. 
A Kelly pad may be improvised by means of a blanket 
rolled army fashion and covered with a piece of rubber 
cloth. 

A square-backed wooden chair should be at hand 



OPERATIONS IN PRIVATE PRACTICE. 249 

in case the Trendelenburg position is necessary, and 
two wooden boxes for the surgeons to stand upon 
when using this posture. 

The lithotomy position can be quickly obtained by 
using a well-padded cane or broom handle placed 
under the patient's knees and bound in place by 
means of a twisted sheet passed around the patient's 
neck, over one shoulder, beneath the other. 

Improvise a sterilizer for instruments and dress- 
ings by using a wash-boiler fitted with a light wood 
inside crate to hold the dressings above the water. 
Sterilize glass tips and syringe bags by placing in a 
towel hammock or muslin sling hung from the 
handle of the boiler. 

The evening before the operation the nurse should 
boil a washboiler full of water and then fill covered 
pitchers, the washboiler and pitchers having first been 
made thoroughly aseptic. The water is conveyed 
from the boiler to the pitchers by means of a perfectly 
clean pitcher or tin ladle. 

On the morning of the operation there should be 
sterilized in the boiler or in an oven six sheets, two 
blankets, twelve towels (not new). The heat should 
be kept up for fully one hour before the operation. 
The dry technic, by which is meant the use of dry 
sponges and gauze, is usually employed in private 
practice, especially when the water-supply is at all 
questionable. 

There will be needed several clean recently boiled 
basins for the various solutions, etc. Two tables 
will be needed — one for the instruments, the other 
for the assistant. They should be covered with freshly 
washed and ironed sheets or towels. There will also 



250 SURGICAL TECHNIC. 

be needed a pail or a washtiib for the soiled water, 
a tin dish or a flat bake-pan for the instruments, 
brandy, a hypodermic syringe filled with the re- 
quired solution, usually strychnin sulphate (^ grain), 
a vSmall tumbler, a Davidson or a fountain-syringe, 




Fig. 193. — Household bulb-syringe (Davidson's). 

table-salt for salt-solution, safety-pins, two new nail- 
brushes, ready for use in a i : 40 carbolic acid solu- 
tion, castile soap, green soap, a razor, hot-water 
bottles, two blankets, alcohol, vinegar, and matches. 




Fig. 194. — Fountain-syringe. 



The surgeon will bring the necessary dressings with 
the instruments, which must be sterilized in the same 
way as in the hospital. 

The instruments are to be wrapped in a towel and 



OPERATIONS IN PRIVATE PRACTICE. 25 I 

allowed to boil for ten minutes in a saucepan, tin 
pail, or a fish-kettle of boiling water, to which have 
been added two teaspoonfuls of washing-soda to each 
pint of water, to prevent rusting. One end of the 
towel must be left hanging out of the kettle as a 
handle by which to lift out the instruments. The 
pail of water should be on the fire and the water 
boiling when the surgeon arrives, so that the instru- 
ments can be put in at once. 

If the nurse is asked to give the anesthetic, she 
should not attempt anything else. None but novices 
give the anesthetic and watch the operation. The 
experienced anesthetizer constantly watches the 
patient. If the nurse is asked to assist the surgeon, 
she must be neither too enthusiastic, nor too quick, 
nor too slow. When the operation is over her duties 
will have nothing peculiar about them. She must 
see the patient safely out of the anesthetic influence, 
and carry the case along as she would any other. 

Sometimes a nurse is called to an emergency oper- 
ation in a very poor family, where there are no con- 
veniences. In such instances the kitchen can be 
cleaned and prepared as an operating-room in a few 
minutes. If she is called in the night and goes to 
the case with the surgeon, she should, while the sur- 
geon is making his examination of the patient, start 
a fire and put on the washboiler, to make sure of 
plenty of boiling water. She should then get six 
sheets and twelve towels, if possible. There may be 
no clean towels, and the nurse will have to wash 
some dirty ones. The sheets and towels can be soaked 
first in boiling water and afterward placed in corrosive- 
sublimate solution (i : 1000), until the surgeon is ready 



252 SURGICAL TECHNIC. 

to use them. Boiling water is one of the best anti- 
septics, as it kills germs on contact. Unfortunately 
it cannot be used in rendering our hands and the field 
of operation aseptic, but it can be used in the prepa- 
ration of the sheets, towels, sponges, and instru- 
ments. 

The kitchen should be rendered as clean as pos- 
sible. The kitchen-table should be prepared for the 
operating-table, and there should be two small tables, 
one for the instrument-tray and one for the sponges. 
If small tables cannot be had, chairs covered with a 
sheet or towels wrung out of the corrosive solution 
will answer the purpose. If there is no gaslight, as 
many lamps as can be obtained should be arranged 
near the surgeon, but not too near the ether, because 
ether is inflammable. 

To fasten a sheet gown upon the operator, fold the 
sheet to a proper length, standing in front of the sur- 
geon, so that the top of the fold is on a level with the 
axilla; draw ends up under the arms behind. Cross 
each end to the opposite shoulder and pin in front to 
form sleeves. 

Improvise a stretcher by means of two curtain 
poles passed through a folded and pinned sheet and 
double blanket. 

After the surgeon has made the examination, the 
part must be shaved, washed, and a towel wrung out 
of corrosive sublimate solution applied, an enema 
given to clear the bowels, and the urine drawn. 
While the patient is being anesthetized the nurse 
may arrange the tables and wash a flat bake-pan 
or meat-pan for the instruments. If sponges have 
been forgotten, a clean sheet can be torn up and 



OPERATIONS IN PRIVATE PRACTICE. 253 

folded into flat sponges. China basins can be used 
for the antiseptics, the sponges, and the surgeon's 
hands; china pitchers for hot and cold water; a 
wash tub for the soiled water; and hot bricks, plates, 
stove-lids, or beer bottles for heaters. 

Cool boiling sterile water for immediate use during 
operation by pouring out in pitchers, which are then 
to be set in vessels containing ice-water and cracked 
ice. 

In cases of contagious diseases, place all cleaning 
cloths and left-over dressings in paper bags or news- 
paper cornucopias to burn. 



CHAPTER XXI. 

GYNECOLOGIC EXAMINATIONS AND 
OPERATIONS. 

Perfect asepsis is of special importance in gyne- 
cologic examinations and operations, because in many 
instances the peritoneal cavity, which is highly suscep- 
tible to septic influences, is invaded by them. We must 
bear in mind that the whole genital tract communi- 
cates directly with the peritoneum, and infection at 
any point may cause peritoneal sepsis. Infection has 
taken place through the introduction of a dirty 
sound, and fatal peritonitis has followed perineor- 
rhaphy and trachelorrhaphy. 

The technic for major operations is usually perfect, 
but for minor operations carelessness is liable to 
creep in. We have no right to expose a patient to 
danger no matter how small the operation to be per- 
formed; and if our technic is not as perfect as we can 
make it with the means at our command, then we 
expose the patient to the greatest of all dangers, that 
of peritoneal sepsis, which usually means death. Suc- 
cess in surgery is due to minute attention to a care- 
ful technic, and a careless nurse may be the means of 
introducing sepsis, which may result in death after a 
most brilliant and skilfully performed operation. The 
most skilful surgeon is dependent upon his assistants 
for the perfection of his technic, and only those nurses 

254 



GYNECOLOGIC EXAMINATIONS. 255 

who have been thoroughly instructed in the practice 
of asepsis and antisepsis should be allowed to assist at 
an operation or examination, however small. 

GYNECOLOGIC EXAMINATIONS. 

The positions which a patient ma}^ occupy when 
undergoing an examination are the knee-chest, dor- 
sal, Sims, and the upright. 




Fig. 195. — Examination in the erect posture (Hirst), 

The upright, or the erect, position is rarely used 
for the purpose of making a diagnosis, but is some- 



256 



SURGICAL TECHNIC. 



times preferred in verifying a diagnosis, especially 
that of uterine dispiacement, previously made witli 
the patient in another position. Around the waist is 
pinned a sheet, which extends to the floor, under 
which the clothing of the patient is drawn up. The 
patient stands with limbs separated, one foot resting 
on a stool or the rung of a chair. 

Dorsal Position. — The patient lies on her back 
with the knees drawn up and separated ; the hips 
are brought down near the 
edge of the table, leaving 
sufficient room for the heels 
to rest together comfortably, 
eight or ten inches apart, 
without slipping from the 
table. A sheet having an 





Fig. 196.— Dorsal recumbent posture. FiG. 197.— Edebohl's dorsal posture. 

oval slit in the center long and wide enough to expose 
the parts is thrown over the patient. In this position 
there is naturally a certain amount of flexion of the 
pelvis upon the trunk, and almost complete relaxa- 
tion of the abdominal muscles is secured. 

Sims^ Position {also called the Latero-abdominal 
Position).— In the Sims position the patient lies on 
the left side of her chest, with her head and left 



KNEE-CHEST POSITION, 257 

cheek resting on a low pillow, and the left arm is 
drawn behind the body or hangs over the edge of the 
table. The hips are brought down to the left-hand 
corner of the table, so that her body lies diagonally 
across it, the head and shoulders being at the right- 
hand side, with the right hand and arm hanging over 
the table-edge. The thighs are flexed upon the abdo- 
men, the right thigh being so flexed that it lies just 
above the left knee, and the feet rest upon a board ex- 
tending from the right-hand corner of the table. This 



Fig. igS.^Sims' posture, anterior \aew. 

position is one in which there is a tendency for the 
intestines to ascend, and this causes the vagina to be 
filled with air and thus brings the uterine cervix 
within easy reach. 

The lithotomy position is used when operating 
upon the rectum and in some conditions of the blad- 
der. The position is obtained by placing the patient 
upon his back, knees and thighs flexed and sepa- 
rated, the hands being drawn down and attached by 
bandaging to the patient^ s feet and ankles. 

The knee-chest, or geiiupectoral, position is much 
used for inspection of the rectum, bladder, vagina, 
and cervix of the uterus. In some cases of displace- 
ment of the uterus the patient may have to take 
17 



58 



SURGICAL TECH NIC. 



this position many times daily. The patient first 
kneels on the edge of the table, then bends forward 
and rests her chest on a low pillow, her head lying 




)l''illl!l!ii!l!!i!!Hli:ilil«l!ill!:ii'iii; 



Fig. 199. — Knee-chest, or genupectoral, posture. 



just beyond, so that her back slopes down evenly, her 
arms clasping the sides of the table. In this position 
the abdominal organs are thrown toward the dia- 
phragm ; the air enters the 
vagina and balloons it out, 
so to speak, so that there 
is an unobstructed view of 
the canal and the cervix. 

The Walcher position 
for increasing the size of the 
outlet of the pelvis during 
childbirth ; action is secured 
by means of elastic and body 
weight extension. 

i^xamination of the Rec- 
tum. — The patient is usually 
placed in the knee-chest 
position. Hither the rectal 
speculum, or in its absence 
a Sims speculum (small blade), is used. When the 
instrument is introduced the rectum becomes distended 




Fig. 200. — Walcher posture. 



GYNECOLOGIC EXAMINATION. 259 

with air so that its walls are well exposed. If the 
patient is not in such a position that the buttocks 
are in a good light, a head-mirror, or an electric head- 
light may be needed. It is well to have these at hand 
in case they shoilld be called for. 

For an examination of the bladder the knee-chest 
position is sometimes used; though, as a rule, the dor- 
sal position is chosen, with the hips elevated high 
above the abdomen by means of cushions or pillows, 
which allows the intestines to gravitate toward the 
chest; and when the urethra is opened the bladder 
becomes distended with air and its interior is thus 
easily seen. Sometimes the patient is anesthetized for 
the examination, since it is usually very painful; but 
local anesthesia of the urethra is often sufficient. 

Preparation for Gynecologic Examination. — 
To prepare a patient for examination the genital 
parts should be cleansed, so that there will be no 
danger of carrying septic material to the upper part 
of the genital tract; the bladder and bowels should 
be emptied. The uterus lies between the bladder and 
the rectum, and the distention of either of these 
organs will alter the position of the uterus. As a 
rule, no douche should be given before the examina- 
tion, since the surgeon may want to see the character 
of the discharge. All bands around the waist must 
be loosened, also the corsets ; a single tight band 
around the waist will crowd down the contents of the 
abdomen and displace the uterus. Around the patient 
is thrown a sheet, beneath which she can raise her 
clothing above the waist, and then step upon a chair 
and thence to the operating-table without there being 
the slightest exposure. 



26o SURGICAL TECHNIC. 

For examination in private practice the patient 
may lie on a small table covered with a shawl, a 
comforter, or blanket. There must be at hand a 
table, covered with a towel, on which are placed two 
bowls, one containing corrosive-sublimate solution 
(i : looo), and the other containing warm water, 
green soap, vaselin, and towels. 

The speculum should be warmed by placing it in 
the warm sterile water. The same aseptic precau- 
tions are used during an examination as during 
an operation. The instruments should be sterilized. 
Sometimes a cleansing douche of corrosive sublimate 
(i : 2000) is administered after an examination. 

PREPARATION FOR OPERATION. 

The preparation for gynecologic operations, such 
as perineorrhaphy, etc., are the same as for an abdom- 
inal operation, excepting the difference of the field 
of operation to be prepared. In case the operation is 
a minor one upon the uterus or vagina, the prepara- 
tions may be somewhat modified according to the 
individual preference of the operator; but the general 
rules of asepsis are always the same; and they must 
be the more strictly observed in these operations be- 
cause the dangers of infection are increased by our 
inability to get the genital tract thoroughly clean. 
In abdominal surgery there is not this difficulty. 

The preparation of a patient in a private house for 
a minor gynecologic operation should be as thorough as 
in a hospital. If the operation is to be performed 
with the patient in bed, there will be needed a wide 
board or an ironing-board for insertion between th^ 



PREPARATION POR OPERATION, 



261 



mattress and sheet, thus making a hard surface for 
the patient to lie upon. 

Griffith's Operating Table-bed. — Elevation is 
secured by means of blocks each four inches square 




Fig. 201. — Griffith's operating table-bed. 



by fourteen inches in length and having a hole two 
inches square and six inches long cut in one end. 

Trendelenburg's position is secured by removing 
the extensions from the head legs after applying a 
broad binder or shoulder straps to the patient. Fow- 
ler's position for securing gravity drainage of the 
peritoneal cavity is obtained by removing the foot 
pieces after slinging the patient by means of shoulder 
straps. 

A piece of rubber cloth or oilcloth wull serve for 
the pad. The material used is folded at the top and 



262 SURGICAL TECH NIC. 

sides, covered with a towel, and the unfolded end 
draped into a pail or wash-tub. When the patient is 




Fig. 202. — Trendelenburg posture. 

anesthetized the bed is turned toward the window to 
afford the surgeon a good light — a northern light if 
possible. A bay window should be avoided, because 
it gives cross-lights. 

The limbs are flexed, the hips brought to the 
edge of the bed, and the pad placed under them, so 
that the water used in bathing the external parts 
is conducted by the cloth into the pail or tub. 
When holding the patient's limbs the nurse should 
let the heel of one foot rest in the palm of her hand; 
the knee of the patient will then rest against the 
chest of the nurse, whose free hand is passed over 
and holds the other limb in position at the knee. 
If the nurse is asked to hold the speculum, she 
should grasp the handle from below with her right 
hand; the angle of the speculum will thus lie in the 



PREPARATION FOR OPERATION. 26 



hollow between the thumb and forefinger, and the 
convexity of the blade will rest on the dorsum of the 
hand. The upper labia and buttocks are raised by 
the left hand. If the speculum or regular retractors 
cannot be obtained in the emergency, retractors can 
be improvised by bending the handles of four large 
spoons to the appropriate angle. Two are used to 
retract the lateral walls, the other two being applied 
to the anterior and posterior parts of the vagina. 

After-care. — After a vaginal operation, trachelor- 
rhaphy, the patient will probably be catheterized for 
a few days. We must always remember the risk of 
cystitis. ]\Iany patients have fully recovered from 
the operation proper, but convalescence has been 
delayed by this complication. 

After passing the catheter the nurse should be care- 
ful that when removing it the urine does not drop 
on the stitches; the parts are afterward sprayed with 
the ordered solution and dried. When giving 
douches the nurse must insert the tube carefully 
away from the stitches ; and after the douche is over 
she should separate the labia and wipe the vagina dry 
with sterilized cotton or gauze held in dressing-for- 
ceps. The same care must be used when giving 
enemas, in order that the rectal and vaginal stitches 
be not broken by the tube. The patient must be in- 
structed not to strain when the bowels are moved, or 
the stitches may break. When dressings are applied, 
they may require frequent changing in order to keep 
them clean and free from discharges. Strict antisep- 
sis must be observed, the genital parts must be kept 
perfectly clean, otherwise septic material will readily 
find access and probably result in infection of the 



264 SURGICAL TECHNIC. 

wound and suppuration, or a stitch-abscess. If the 
uterus is packed with gauze, the pulse and tempera- 
ture are usually taken every two hours ; and should the 
temperature rise to 101° F. the packing is removed. 

Diet. — A liquid diet is usually ordered until after 
the third day, when the bowels will have been 
moved; after which, if all is well, the amount of food 
is increased until it attains its customary proportions. 

The patient is generally kept in bed two weeks, 
and the sutures removed on the ninth day in the 
order in which they were introduced. After the re- 
moval of the stitches many operators order a vaginal 
douche two or three times a day, the amount of water 
varying from four to six quarts. This treatment is 
successful only when the douches are given at the 
proper time and temperature. 



CHAPTER XXIl. 
DIET RECIPES. 

From the following carefully prepared and long- 
used foods for the sick the nurse will be enabled to 
quickly choose a change of diet from day to day, 
enabling her to secure the fresh, dainty daily sur- 
prise for her patient: 

Water.— Boiled water is the saftest and best for 
the sick. Reaerated by pouring out in flat receptacle. 
It may be cooled by keeping in ordinary milk bottles 
set on ice. 

Albumin Water. — Beat up the white of one egg 
very light; strain through a cloth; add a glass of 
water. Stir in a teaspoonful of lemon juice, one of 
sugar, and a pinch of salt. Serve set in a bowl of 
cracked ice. 

Apple Water. — Bake two apples soft, mash; pour 
a cup of boiling water over the mass; cool; strain; 
sweeten to taste. Serve with shaved ice, or set in a 
bowl of cracked ice. 

Ivime Water. — Take a lump of unslaked lime the 
size of an egg^ and place it in a half-gallon bottle of 
pure cold water. Keep the bottle corked; after a few 
moments the lime water is ready for use, the clear 
liquid being poured off as needed. So long as any 
lime remains the bottle may be restocked by the mere 
addition of cold water. 

265 



266 SURGICAL TECHNIC. 

Barley Water. — Stir two ounces of pearl barley in 
a pint and a half of cold water; boil for half an hour 
over a slow fire in a covered vessel; strain. Add 
thin cuts of lemon, or pieces of sugar rubbed over the 
lemon to flavor. 

I/emonade. — Cut a lemon in half after rolling; 
squeeze one-half into a glass, removing the seeds; 
add a little water and stir in a heaping dessertspoonful 
of sugar. Fill up the glass with water; stir in more 
sugar if necessary. 

[Effervescing I/emonade. — Add half a teaspoonful 
of bicarbonate of soda to the above; or may use 
Vichy water to make. 

Egg I/emonade.— Shake up the white of one ^<g^ 
in a cup of water, to which add two teaspoonfuls of 
lemon juice and sugar; shake. Serve at once. 

Imperial Drink. — Add a teaspoonful of cream of 
tartar to a pint of boiling water; squeeze and add the 
juice of half a lemon; add a dessertspoonful of sugar. 
Serve cold. 

Tamarind Water.— Stir a tablespoonful of pre- 
served tamarinds up in a cupful of boiling water; 
allow to cool; strain. Serve with shaved ice. 

Currant Juice.— To a tablespoonful of currant 
jelly add a cupful of boiling water, stirring; sweeten 
to taste; set aside to cool. Serve with ice. 

Orangeade. — Peel an orange; pour a cupful of 
boiling water over the peeling; squeeze and add the 
juice of the orange and a dessertspoonful of sugar; 
let cool; strain. Serve cold with shaved ice. A tea- 
spoonful of lemon juice may be added to vary the taste. 

Milk Diet. — This consists of two or three quarts of 
milk daily. 



DIET RECIPES. 26/ 

Koumyss. — Dissolve a third of a cake of com- 
pressed yeast in a little lukewarm water; add this to 
a quart of fresh, warm milk; stir in a tablespoonful 
of sugar. Put the mixture in stoppered bottles; cork 
and set away for twelve hours in a temperature of 
about 70° F. Then put the bottles upside down on 
ice till ready for use. 

Toast Water. — Remove the crust from a slice of 
stale bread; toast without burning. Break the slice 
up and put the fragments into a small crock or 
pitcher; add a couple of pieces of orange peel or 
lemon. Pour over all a pint of boiling water: cover 
with a napkin; let cool; strain for use. Must be 
made fresh. 

Toast Soup.— Toast a thin slice of stale bread. 
While hot, spread butter over it, having no excess. 
Break into fragments and place in a pitcher; add 
three-quai ters of a pint of boiling water; add a pinch 
of salt and pepper. Serve hot. 

Flaxseed Tea. — x\dd one-half cup of flaxseed to 
one quart of boiling water. Boil for one-half hour 
over a slow fire. Allow to set near the fire for fifteen 
or twenty minutes; add a teaspoonful of lemon juice; 
sweeten to taste; strain. Serve hot or cold. 

Slippery elm bark may be added to the above mix- 
ture, allowing half an ounce of the bark to a pint of 
liquid. 

Milk and Cinnamon.— To half a pint of new milk 
add enough broken cinnamon sticks to flavor; add to 
this a teaspoonful of sugar; strain. Serve cold or hot. 

Arrowroot Gruel.— Stir up half a tablespoonful 
of arrowroot flour with a little cold water; add a cup- 
ful of water, stirring in half a dessertspoonful of sugar 



268 SURGICAL TECHNIC. 

and a pinch of salt. Boil slowly for twenty minutes, 
stirring constantly; add a cupful of milk; boil; strain. 
Serve hot. 

Barley Gruel.— Stir up a tablespoonful of barley 
flour in a little water; add a cupful of water in which 
has been mixed half a dessertspoonful of sugar and a 
pinch of salt; heat; bring to a boil, continuing it for 
twenty minutes; stir constantly; add a cupful of 
milk; bring to a boil; strain. Serve hot. 

Cracker Gruel.— Dissolve half a teaspoonful of 
sugar and a pinch of salt in a cupful of water ; apply 
heat. Mix up two tablepoonsfuls of grated cracker in 
a little water and add to the heated water. Boil for 
five minutes; add a cupful of milk and again bring to 
a boil. Serve hot. 

Flour Ball. — Tie up half a pint of flour in a square 
of cheese-cloth very tight; place in a pot of boiling 
water; cook for five hours. After removing the cloth 
peel the outside of the ball and grate; dry in the oven 
and keep in a closed jar. This may be used for mak- 
ing gruels; also to dilute milk for young children. 

Tapioca Jelly. — Soak a cupful of tapioca for two 
hours; when soft, place in a saucepan; add a dessert- 
spoonful of sugar; the rind and juice of one lemon; a 
pinch of salt and a pint of water ; heat, stirring the 
mixture until boiling; turn into a mold and set out to 
cool before serving. 

Tapioca Soup. — Boil a pint of meat broth ; stir in 
an ounce of washed tapioca. Set on the back of the 
stove to simmer, covering the vessel. Skim and serve 
hot. 

^§SfS. — Boil eggs by dropping them into boiling 
water, and continue for three minutes. 



DIET RECIPES. 269 

Poached BggS. — Bring water to a boil in a sauce- 
pan; add a pinch of salt; slip the ^'g^ carefully broken 
in a saucer into the salted water. Cook until the white 
is firm but jelly-like; remove with a skimmer and serve 
on a thin piece of buttered toast; sprinkle a little salt 
and pepper on the top; garnish with parsley sprig. 
Serve at once. 

Scrambled lEggS. — Beat up two eggs thoroughly; 
add two tablespoonfuls of milk; a pinch of salt. Pour 
into a very hot frying pan, buttered; stir constantly for 
about two minutes. Serve on buttered toast at once. 

Shirred BggS. — Heat up the shirring cups. Put 
in each cup a bit of butter; break into each an ^gg. 
Allow to remain on the stove for a moment, then 
serve hot in the cup, adding a pinch of salt. 

Panado. — Take a slice of wheat bread and break 
up into fragments; sprinkle a teaspoonful of ground 
cinnamon over the whole; add a pint of boiling water; 
boil for five minutes; add a teaspoonful of sugar and 
a little grated nutmeg. Serve hot. 

Milk Toast. — Prepare two slices of crisp toast. 
Heat a cup and a half of milk to the boiling point; 
add a pinch of salt and a small bit of butter; thicken 
the milk by adding one-half teaspoonful of corn- 
starch; stir well and boil for five minutes. Pour the 
milk mixture over the toast in a closed dish. Serve 
hot. 

Rennet. — One pint of milk warmed, sweetened, 
and flavored with nutmeg, cinnamon, or lemon; add 
one large teaspoonful of liquid rennet; stir for one 
minute; set aside to cool and set. Serve with sugar 
and cream. 

[Boiled Rice. — Rice must continue to boil until 



270 SURGICAL TECHNIC. 

every grain is softened without dissolving into a 
shapeless mass. 

Plain Rice. — Two tablespoonfuls of rice are to be 
washed and placed in a shallow baking dish; add two 
tablespoonfuls of sugar; flavor with lemon peel or 
vanilla; add one quart of milk. Bake for three hours 
in a moderate oven, stirring every twenty minutes. 
Cool for an hour before using. Serve cold. 

Tapioca Pudding-.— Soak one-half cup of tapioca 
over night in cold water; put it over the fire and heat 
to clearness. Mix up one pint of milk and two eggs 
to form a custard by heating the mixture until almost 
boiling, then stir in two tablespoonfuls of sugar and 
cook for three minutes in a double boiler, stirring 
gently all the time. When done it should be as thick 
as cream. If allowed to cook too much it separates 
and is spoiled. Add the milk custard to the tapioca; 
sweeten and flavor to taste; bake in a quick oven. 
Set aside to cool. Serve cold. 

Cornstarch. — To one tablespoonful of cornstarch 
add cold water enough to make a smooth paste. Add 
to this half a pint of milk; boil for five minutes, stir- 
ring all the time; add a pinch of salt; sweeten to taste, 
and add a flavoring extract. Serve cold. 

Beef Bssence. — Cut up one pound of fresh lean 
beef from the neck into small pieces; sprinkle a little 
salt over the mass; place the cut-up meat into a stout 
stone jug; place the jug in a vessel of cold water and 
bring to a boil; cork the jug tightly when steam 
begins to issue from the mouth. Continue boiling for 
at least four hours; strain through a cloth, and season 
the meat juice obtained with pepper and salt to taste. 
- Invalid's Soup.— To one pint of beef essence made 



DIET RECIPES. 2/1 

quite hot add half a pint of cream, likewise hot, to 
which the yolk of a fresh ^%^ has been stirred up. 
Mix carefully together in a lined saucepan; season 
and serve. 

Beef Broth. — Take a pound of beef (neck or shoul- 
der) and slice it up; place in a pan and salt, then 
pour on a quart of cold water; place on the fire and 
bring to a simmer; keep so over a slow fire an hour 
and a half; set back on the range for half an hour; 
strain; serve. 

Mutton Broth. — Cut up a pound of good mutton 
into small pieces and sprinkle with salt; allow to sim- 
mer over a slow fire, after adding one quart of cold 
water, for an hour and a half; boil for half an hour; 
strain; serve. 

Beef Juice.— Take half a pound of lean beef and 
cut it up in pieces of about the size of a pigeon's ^%%\ 
toast the pieces over hot coals; squeeze out the juice 
with a meet presser or lemon squeezer; add a pinch 
of salt before serving. 

Chicken Broth. — Take a small chicken, removing 
skin and fat between the muscles; divide it in two 
down the back; remove the lungs as w^ell as every- 
thing adhering to the side-bones and back; cut up the 
halves in thin slices; place them in a pan and sprinkle 
with salt, then add a quart of cold water; bring to a 
simmer over a slow fire; allow to remain for an hour 
and a half. Then remove from the fire to a place 
where the heat will still be kept up for half an hour 
longer; strain; serve hot. During the cooking a sprig 
of celery may be added, or a clove, or half a dozen 
pepper-corns to give it a flavor. 



CHAPTER XXIII. 
SIGNS OF DEATH ; AUTOPSIES, 

WiNSLOW, one of the professors at the University of 
Paris, and who had twice been taken for dead, was the 
first to make a scientific investigation of the signs of 
death. After Winslow came Ivouis, and since their 
time eminent men, especially in countries prescribing 
rapid burial, have endeavored to find certain and 
reliable signs of death before decomposition begins. 

SIGNS OF DEATH. 

Absence of respiration is not a sure sign of death, 
as it may be due to syncope or to the person being in 
a trance; nor is absence of the heart-beat, imless 
determined by means of a stethoscope in experienced 
hands. Coldness and rigidity may be due to collapse 
or catalepsy or in persons who are frozen stiff. 

In doubtful cases of apparent death which occur 
suddenly or from external violence the following 
tests are usually applied : 

1. The absence of the heart's action is carefully 
determined by a stethoscope or phonendoscope. 

2. Absence of the circulation is ascertained by 
tying a string tightly around a finger or a toe; if the 
tip becomes blue, life is not extinct, though this may 
occur in cases where there has been great loss of 

272 



SIGNS OF DEATH. 



273 



blood, and in other cases where the heart is too weak 
to send the arterial blood into the capillaries of the 
fingers. 




Fig. 203. — Stethoscope. Fig. 204. — Bazzi-Bianchi's phonendoscope. 



3. Absence of respiration is determined b}^ placing 
the surface of a mirror before the mouth ; if the sur- 
face becomes moist, respiration has not ceased. 

4. If a subcutaneous injection of aqua ammonia is 
given a red or purple spot will form if life still exists. 

18 



2/4 SURGICAL TECH NIC. 

5. If a needle is inserted into the flesh of a living 
person blood will escape, but not if life is extinct ; 
still, if there has been a large loss of blood, there will 
be no escape of blood in the living. 

Rigor mortis (post-mortem rigidity or stiflfness of 
death) begins in the upper part of the body, usually 
in the maxillary muscles, and spreads gradually from 
above downward. It disappears in the same order. 
It comes and goes quickly after great muscular efibrt 
or excitement, and when once it has been broken 
up it does not return. The time it sets in after death 
varies from ten minutes to twelve or even twenty-four 
hours. Rigor mortis is considered the most positive 
sign of death, because it indicates death of the mus- 
cle itself. 

Death of the body as a whole takes place first, and 
at intervals of an hour or even several hours death of 
one or other of the involuntary muscles follows. 

Hypostasis, cadaveric lividity, or congestion of 
blood in the capillaries, which forms in all the de- 
pendent parts of the body, is considered a valuable 
sign of death, but this purple color may be due to 
contusion, and has been seen in cholera patients 
before death. 

The body-temperature at and from one to two 

hours after death may be very high, 107° or 112° F. 

Patients dying from cholera and yellow fever have 

high temperatures for several hours after death; but, 

as a rule, the body is cold to the touch in from six to 

ten hours. 

AUTOPSIES. 

Every nurse should do all in her power to assist 
the physician or surgeon to obtain autopsies, and 



AUTOPSIES. 275 

with a little tact the necessary permission can usually 
be obtained. Every well-conducted autopsy adds 
more or less to medical knowledge. It verifies the 
diagnosis of the illness, and in many cases it explains 
or shows the cause of symptoms the explanation of 
which could not be determined before death. In 
surgical work, when a patient dies in less than 
twelve or fourteen hours after an operation, the au- 
topsy, when made by a competent bacteriologist and 
pathologist, will show whether death was due to 
sepsis or to some organic disease over which the sur- 
geon had no control. 

In a private house the autopsy should be held in 
the room giving the best light, and if possible in the 
daytime in order to obtain the correct color-interpre- 
tation; for if made in artificial light the observations 
will not be entirely trustworthy. 

At the present time an autopsy is perferably held 
almost immediately after death, and before putre- 
factive changes have taken place. The undertaker 
should always be warned not to inject the body, be- 
cause the fluids usually employed, which contain 
among other things corrosive sublimate and arsenic 
in large quantities, change the color and consistency 
of the organs to such an extent that it is difficult to 
recognize the pathologic processes. Then, again, the 
punctures made during the embalming process may 
open an abscess or other cavity, and thus distribute 
the contained pus or exudates. Embalming-fluid 
has been poured into the mouth, and having found 
its way into the lungs and stomach, has greatly 
changed the appearance of those organs. 

The clothing on the body should be removed and 



276 SURGICAL TECHNIC, 

a large sheet spread over it; or if preferred, a night- 
dress or skirt open down the middle may be put on. 

If the corpse is female, braid the hair in two plaits 
after combing a part extending from ear to ear over 
the crown. Coil each plait securely with hair-pins. 

The things a nurse should provide are: 

1. I^arge rubber sheet, old oil-cloth, old quilts, or 
papers to put under trestle to protect the floor. 

2. Small table for instruments, a marble-top table 
if possible, unless there is a marble-top stationary 
bowl in the room. 

3. Three washbowls: one for corrosive sublimate, 
one for dirty instruments, and one for organs re- 
moved. 

4. Two pails for dirty water. 

5. Old towels and a number of old sponges. 

6. Plenty of hot and cold water. 

7. About four quarts of fine sawdust, or oakum, 
or excelsior packing, absorbent cotton, or common 
cotton for filling up cavities, any one of which will 
prevent fluid oozing through the incisions. When 
these are not obtainable, bran, cloth, or newspapers 
may be used. Fine sawdust is the best material, as 
it packs easily, does not interfere with the sewing 
by getting into the stitches, and keeps the needle 
dry. 

8. Six wide-mouthed bottles in which to place 
specimens from the various organs, and which can 
be securely corked. 

9. Mucilage and labels on which to write the his- 
tory of each specimen in the bottle. 

10. About three yards of fine twine or carpet- 



AUTOPSIES. 277 

thread, and a large darning-needle or a large curved 
needle. 

Should the autopsy take place in a house where 
there are no conveniences, the body can be left lying 
on the undertaker's stretcher covered with a sheet, 
the clothing removed, and a large napkin put on. 
There should be several old newspapers to protect 
the floor, and on which to place the dirty instru- 
ments and organs removed; an old sheet, a pail, 
a wash-bowl, and a pitcher of warm water can always 
be obtained. 

The sheet is torn into four pieces. Two pieces are 
used, one for each side of the neck and trunk, cover- 
ing the arms, leaving the chest and abdomen free for 
the surgeon to operate; the third piece is placed be- 
neath the head; and the fourth piece is tucked in 
below the genitals, thus covering the lower extremi- 
ties. The bowl contains the large dampened sponge, 
and, together with the pail, should be placed within 
convenient reach. 

Absolute cleanliness is essential at a private autopsy. 
Blood-stains must be washed from the walls, floor, 
dishes, the rubber or oil-cloth; the papers, old 
sponges, and cloths should be burned, and the body 
must be washed perfectly clean. The room must be 
left in perfect order — just as it was before the post- 
mortem. Ground coffee thrown on a few live coals 
will remove all odor from the room. 

For removing the odor from the hands, turpentine 
will be found serviceable, or a solution of per- 
manganate of potassium and oxalic acid, or a dilute 
solution of formaldehyd. The result of the autopsy 
must be kept secret and revealed to no one. 



CHAPTER XXIV, 

HYGIENE; PERSONAL CONDUCT OF A NURSE'S 
LIFE; OF THE REWARDS; SUCCESS. 

The: care of her own person must not be forgotten 
by the aspiring nurse, else she may gain the coveted 
post of trusted helper to physicians at the price of 
loss of her bodily health. Rest and regularity in 
conducting her mode of life are the chiefest factors 
for securing a continuation of the sound health con- 
ditions which every nurse should possess who 
attempts the work of caring for the sick. Futile 
as it may seem to suggest rest and regularity to one 
whose professional life is largely made up of activity 
and irregularity of mode of personal life, it is never- 
theless essential for a good nurse to learn how to 
save up energy during ordinary times that she may 
have sufficient vital capital force to meet the emer- 
gency demands. 

Sufficient sleep and a regular time for eating is as 
important for the well as the sick, and in the matter 
of eating it must be recalled that a mouthful of food 
which has been well masticated before swallowing 
will give much greater return in energy than many 
of the hurried mouthfuls which nurses are too prone 
to take. 

Attention to the calls for emptying of the bladder 
and the bowels is for the most part made a matter 
of convenience rather than considered as most im- 

278 



PERSONAL CONDUCT OF A NURSE'S LIFE. 279 

portant functional activities to be attended to without 
delay. 

Daily stimulation of the skin of the entire body by 
bathing, even if but a sponge bath taken from a 
wash-bowl or a basin, is to be recommended, for 
while the average nurse may be forced to scrub her 
hands and arms too often for either health or com- 
fort, there is seldom allowed time enough for suffi- 
cient body bathing. 

A nurse who spends a day a month in bed during 
the beginning of her monthly sicknesses will often 
be considered selfish, and she may now and then lose 
a position temporarily by following such a course, 
but her increased value to herself and to the profes- 
sion she serves during the rest of the month will far 
outweigh the apparent disadvantage. 

The presence of decayed teeth, corns, bunions, 
varicose veins in the legs, and hemorrhoids are all 
common affections which may be borne a long time, 
but the nurse who has such things may come to a 
time of final failure in her professional career. Upon 
the very first appearance of the handicapping condi- 
tions mentioned she must seek relief, for the best 
that medical and surgical advice and treatment can 
give is hers by right. Aside from the ordinary affec- 
tions which arise from ill-fitting shoes, nurses are 
particularly liable to the condition called "footsore," 
student nurses being special sufferers. While the 
hard floors of modern hospitals are responsible for 
the condition during the earliest da^^s of a nursing 
career, later its control is a matter of proper care of 
the feet themselves. A nurse must seek foot com- 
fort and health not by wearing her oldest, run-down 



28o SURGICAL TECHNIC. 

shoes, but always during working hours a well-fit- 
ting, ample sized shoe which allows her toes to lie 
uncramped. The other essential for comfort is to 
keep the feet dry. Perspiration quickly softens the 
skin of the feet, and allows swelling in the soft cel- 
lular tissue beneath to take place. While a perspir- 
ing foot is by no means unhealthy, the relaxation 
which accompanies it calls for treatment. To over- 
come the effects of excess the following measures 
will be found useful : A daily change of shoes ;' one 
or more changes of stockings during the day ; stimu- 
lating foot baths, alternating hot and cold water, 
accompanied by rubbing with a coarse towel and 
massage ; alcohol bath and rub ; painting the soles 
of the feet with a lo to 20 per cent, formalin solu- 
tion once or twice a week ; talcum powder, rice flour, 
fuller's earth dusted in the shoes; paper insoles," made 
from newspaper after folding several leaves, and cut to 
the size of the stockinged foot, will be found invalu- 
able in keeping the feet both dry and warm. A daily 
change may be made at the time of dressing. In 
general, high laced shoes with low heels will prove 
more comfortable than the low light-weight ties. 
Rubber heels are restful, as they greatly reduce body- 
jarring. Tendency to flattening of the arches of the 
feet, manifested by a continuous ache upon standing, 
may be overcome by massage, strapping and bandag- 
ing, or supported by sole-plates. 

The continual scrubbing and immersions in the 
various antiseptic solutions of hands and arms which 
the modern nurse is compelled to undergo often gives 
rise to discomfort, if not to well-marked skin disease. 
Drying up of the normal oil of the skin is the earliest 



PERSONAL CONDUCT OF A NURSE'S LIFE. 28 1 

direct cause of roughness, cracking, and scaling skin. 
A peculiar sensitiveness of certain individuals' skins 
for such drug solutions as carbolic acid, bichlorid 
of mercury, and oxalic acid, which act toward them 
as special irritants, and which is known by the term 
idiosyncrasy, is not considered. In general, to keep 
the hands pliant by massage and the free use of cold 
cream, lanolin, or some such bland ointment, will 
suffice. In cases which fail of relief, rubber gloves 
must be worn. 

The importance of cultivating her powers of obser- 
vation can hardly be estimated, so much will the 
nurse's reliability be thereby increased. After making 
the first general observation, her duty is to note 
changes, to see and jot down facts, not bias her ob- 
serving faculty by evolving opinions. 

A good nurse makes no noise herself, and acts as a 
perpetual noise preventer in and around the sick- 
room. 

The stricter a nurse holds herself to the prescribed 
uniform of her school the better, thus fancy collars, 
and neckwear, jewelry, and hair ornaments, finger- 
rings, detract her personality from the role she 
plays. 

The calling of a nurse demands that she be always 
neat and trim in the matters of her personal appear- 
ance and in clothing effects, and that her professional 
relationship with the patient, his family, and the 
physician call for but the ordinary dignity which be- 
comes a woman's greatest charm when least assumed. 

While the mental caliber of the successful nurse is 
from necessity large, she will do well not to con- 
tinually tax herself with the requirements of her art. 



282 SURGICAL TECHNIC. 

Proper amusements have their place, and will the 
better equip her for the serious work hours. 

Nurses will do well to study surgical supply cata- 
logues, so as to know the cost of supplies and keep 
abreast of what is new. A postal request will suffice 
to supply her. 

No matter how physically well a nurse may con- 
duct her life, it becomes a necessity for her to secure 
a change of scene during a month or two of the year, 
which may be obtained by means of a "travelling 
case," by connecting herself with work in some dis- 
tant part of the country through correspondence, or 
the channels of a medical journal's advertisement 
columns, or by expending part of her year's savings 
for board in the country or at the seashore. Every 
nurse's bureau should have its correspondence depart- 
ment to provide for this ' ' exchange ' ' system in prac- 
tice over the country. Besides rest in change of en- 
vironment the results will be better, because broader, 
educated nurses. Of the rewards for conscientious 
work the nurse's outlook is a bright one, for better 
salaries are offered and more may be expected to be 
paid in the future for high class work than ever before. 
The matter of money loss to nurses, which occurs be- 
tween " cases," is to be overcome by a mutual division 
of expenses, as is customary in large communities. 
Five or six nurses "keep house " in a few rooms, the 
one who is professionally unemployed acting as 
** housekeeper." By this means direct communica- 
tion is kept up between doctors and nurses. While 
the agency system for hiring nurses is good, a sure 
plan for a nurse to gain cases is by periodic personal 
visitations upon doctors. A nurse who calls upon a 



PERSONAL CONDUCT OF A NURSE'S LIFE, 283 

physician and tells him what she can do and the scale 
of her prices for her work has made an impression, 
and she will be remembered by the doctor when in 
need of a nurse's aid. 

Individual success for the nurse, as in any other 
vocation, must be the sum-up of her whole life's 
w^ork. If at the commencement of her career she 
learns to know herself as a helper — one whose life's 
work is dedicated to the sick and to a loyal devotion 
to the medical profession, of which she is herself a 
most important part — such a one is well started in her 
career, and is on the high roa^ toward success and 
honor. 



GLOSSARY 



A. 

Abdominal binder. A wide band- 
age dressing used to support the walls 
of the abdomen after open operations 
or the womb after childbirth. MusKn, 
flannel, or towelling may be used, 
and is applied snugly by overlapping 
tails and fastening or by safety-pins. 

Abdominal operation. An opera- 
tion which involves opening the ab- 
dominal cavity as a prehminar}'. 

Abdominal section. An opera- 
tion in which the belly cavity is 
opened. 

Abscess. A circumscribed collec- 
tion of pus. 

Acetic fermentation. Souring 
with the production of acetic acid or 
vinegar. 

Actinomycosis. A disease of cattle 
which may be transmitted to man; it 
is due to the ray fungus. 

Active h3rperemia. Steady in- 
crease of the quantity of blood in 
the vessels of a part. 

Acupressure. Compression of a 
blood-vessel by twisting with an in- 
serted needle. 

Acute disease. One active in on- 
set, energetic in course, and of short 
duration. 

Aerobic. Requiring the presence 
of oxygen for development. 



I Albumose. A substance formed 



during the digestion of albumin. 

Alimentary canal. The digestive 
tube extending from the mouth to the 
anus. 

Alterative. A medicine having a 
gradual and general tendency toward 
the production of health. 

Anaerobic. Requiring absence of 
oxygen for growth to take place. 

Anesthetic. Producing uncon- 
sciousness to pain. 

Aneurysm. A disease of blood- 
vessels due to stretching or rupturing 
of one or more of the coats. 

Aniline derivative. An agent 
prepared from coal-tar. 

Anthrax. A contagious disease 
of cows and sheep often transmitted 
to man, due to the Anthrax bacillus. 

Antiseptic. An agent by whose 
action germs are destroyed or their 
growth prevented. 

Antiseptic agent. One which 
inhibits the growth or destroys germs. 

Antiseptic surgery. The various 
procedures which are carried out with 
the idea of preventing or destroying 
germ contamination. 

Antistreptococcic serum. A pro- 
tective blood- water taken from an 
animal which has successfully recov- 
ered from graded injections cf virulent 
pus germs. 

285 



286 



GLOSSARY. 



Antitoxin. A defensive proteid 
developed in a body for its protection 
from microbic assaults; a curative 
blood serum. 

Aqua ammonia. Ammonia-water. 

Arterioles. Smallest branching 
arteries. 

Artificial inoculation. Attempt 
to produce a disease by injection or 
local application of the germs, their 
products, or the virus producing it. 

Artificial media. An agent cap- 
able of supporting germ life outside 
of the body. 

Asepsis. Freedom from septic 
poisoning; clean. 

Aseptic. Free from germs; sterile. 

Astringent. An agent which causes 
contraction of tissues and the lessen- 
ing of secretions. 

Atomizer. An appliance for spray- 
ing. 

Aural. Pertaining to the ears. 

Aural canal. The ear passage. 

Autopsy. The examination of a 
dead body, a post mortem. 

Autopsy room. A room set aside 
for the examination of dead bodies. 

Axilla. The arm-pit. 

B. 

Bacilli. Rod-shaped germs, as 
tubercle bacilli, the cause of consump- 
tion. 

Bacteria. Minute organisms; mi- 
crobes. 

Bacteriologist. One who studies 
and experiments with germ life. 

Bacteriology. The study of germs. 

Bed heater. An appliance for 
heating a bed, as with a hot- water bag, 
hot bricks, etc. 

Beef essence. Concentrated beef 
extract. 



Bistoury. A sharp narrow-bladed 
surgeon's knife; may be sharp or dull 
pointed; curved. 

Blastomycete. Yeast-forming 

germ. 

Blood serum. The watery portion 
of animal fluids. 

Boroglycerid. A pasty compound 
made by slowly dissolving two parts 
of boric acid in three parts of hot 
glycerin. 

Bouillon. Strained beef soup; a 
culture-medium. 

Bronchi. The first division of the 
windpipe. 

Bronchioles. The finest divisions 
of the windpipe. 

Bronchorrhea. Excessive flow of 
mucus from the windpipe. 

Bubonic plague. An acute, con- 
tagious disease characterized by a 
malignant type of fever and forma- 
tion of buboes or glandular swellings 
throughout the body. 

Buttocks. The fleshy parts back 
of the hips. 

c. 

Cancer. A morbid growth whose 
tendency is to spread and to cause 
ultimate death. 

Capillaries. The finest divisions 
of the blood-vessels. 

Capillary hemorrhage. Oozing 
of blood. 

Carcinoma. One form of cancer; 
common seat is the female breast. 

Catalepsy. Condition of partial or 
complete suspension of will and con- 
sciousness, with rigidity of voluntary 
muscles. 

Catheterization. The act of draw- 
ing off the urine. 

Catheterize. To draw off the 



GLOSSARY. 



287 



Cellular tissue. Loose fatty spaces 
beneath the skin and between organs. 

Cerebrospinal fluid. Serous fluid 
contents of the cavities of the brain 
and spinal cord. 

Cervical canal. Channel in the 
neck of the womb connecting the 
vagina with the body cavity of the 
womb. 

Chemic. Chemical; relating to 
chemistr}'. 

Chill. A nervous symptom usu- 
ally marking the onset of disease, in 
which the patient has rigors and com- 
plains of being cold; in malarial fever 
the temperature is really highest at 
this time. 

Chlorinated soda. Soda which 
has been combined with chlorin. 

Chlorin -water. A saturated solu- 
tion of chlorin in distilled water. 

Citronella. A fragrant Asiatic 
grass from which is obtained a volatile 
oil, useful, when applied to the person, 
in driving away mosquitoes. 

Clammy. Moist and cold. 

Clamp. An instrument with de- 
tachable handles to apply to the 
broad ligament; in operations for 
removal of the uterus through the 
vagina, six or eight are applied upon 
each side. A hemostatic forceps to 
control hemorrhage from vessels that 
cannot be reached to apply ligation. 

Clostridium. A bacillus distended 
at its center by a large spore. 

Coagulable quality of blood. The 
power to clot. 

Cocainization. The act of pro- 
ducing cocain anesthesia. 

Collapse. General failure of the 
vital powers without loss of con- 
sciousness. 

Colony. A localized, unmixed 
growth of micro-organisms. 



Complication. A disease appear- 
ing during the course of another, 
which may modify the termination. 

Contagious. Capable of being 
transmitted from one individual to 
another; catching. 

Contagious affection. A disease 
directly transmissible from one person 
to another. 

Contagious disease. One which 
may be directly transmitted from one 
to another. 

Convalescence. The period of 
uninterrupted recovery- from ill- 
ness. 

Convulsion. A nervous condi- 
tion giving rise to violent, continued, 
or intermittent muscular contrac- 
tions. 

Corrosive sublimate. Bichlorid 
of mercury. 

Coryza. Cold in the head. 

Cranioclast. An obstetrical in- 
strument to aid in the delivers' of a 
child's head by crushing. 

Crystalline. Colorless; clear as 
cr}-stal. 

Culture -media. Substances upon 
which germs are experimentally 
grown. 

Cumol catgut. Catgut sterilized 
for surgeon's use by superheating in 
a solution of cumol, a product of 
coal-tar. 

Curetting of uterus. Clearing 
out of the contents of the womb or 
scraping the membranous lining of 
its cavity. 

Cyanosis. The symptoms arising' 
when the supply of oxwgen is greatly 
lessened, as in strangulation. 

Cyst. A circumscribed membran- 
ous cavity occurring abnormally and 
containing fluid, semifluid, or solid 
contents. 



288 



GL OSSAR V. 



Cystitis. Inflammation of the 
bladder 

Cystoscopic examination. A study 
of the bladder by the use of an in- 
strument which brings its surface di- 
rectly into view. 

D. 

Decomposition. Act of decaying; 
rotting; separation into elements. 

Delirium. Mental state in which 
there is a rapid flight of ideas which 
are incoherent and often unintelli- 
gible. 

Depletion. Reduction of the 

amount of fluid, as blood or serum, in 
a part. 

Diabetic coma. Loss of con- 
sciousness due to the action of poisons 
in diabetes. 

Diaphragm. The great breathing 
muscle separating the chest from the 
abdomen. 

Dilatation of cervix. Act of 
stretching the mouth and neck of the 
womb. 

Disinfectant. An agent capable 
of destroying microbes or the prod- 
ucts of their growth. 

Disinfection. The act of render- 
ing free from micro-organisms or 
their effects; purifying. 

Distillation. The act of heating 
a solid or liquid in an apparatus, so 
that the vapors given off may be 
collected. 

Douche. A more or less forcible 
flushing of a cavity or part of the body 
for purposes of cleansing and stimula- 
tion. 

E. 

Eclampsia. Convulsions during 
the childbearing period caused by 
kidney disease. 



Ecraseur. An instrument used to 
squeeze its way through tissue causing 
least amount of bleeding by employing 
a gradually tightening wire or string. 

Eczematous condition. One in 
which peeling and crusting of the skin 
occurs with more or less itchiness. 

Edema. Swelling due to excess of 
serous fluid within a tissue. 

Effervescence. Bubbling. 

Elaborated. Developed; pro- 
duced 

Electrolysis. Decomposition by 
electricity. 

Elimination. The act of throw- 
ing off; expelling. 

Emergency operation. One made 
necessary by the serious condition of 
the patient. 

Emesis. Vomiting. 

Emetic. A substance causing 
vomiting. 

Emulsion. A fluid containing fat 
suspended in very fine particles, form- 
ing an opaque, milky white mixture. 

Endocarditis. Inflammation of 
the lining membrane of the heart. 
The process is usually confined to the 
valves. 

Endometritis. Inflammation of 
the lining of the womb. 

Enemata. Rectal injections; solu- 
tions used to cleanse the lower bowel. 

Enter oclysis. The administration 
of a rectal injection. 

Epidemic. A general invasion of 
a community by a given disease. 

Epidemic cerebrospinal menin- 
gitis. A microbic disease giving rise 
to inflammation of the lining mem- 
branes of the brain and spinal cord 
with convulsions, irregular fever, and 
a rash. 

Epidermic. Injected; relating to 
the skin. 



GLOSSARY. 



289 



Epidermis. The surface-covering 
of the body; the skin. 

Epithelial cells. Microscopic 

units; flat upon the skin, goblet- 
shaped on mucous membranes, form- 
ing the surface layers of these tissues. 

Epithelium. Skin covering. 

Eruptive fever. One attended 
with a rash; scarlet fever. 

Erysipelas. An acute contagious 
skin disease caused by streptococci, 
giving rise to irregular fever, and with 
a tendency to relapse. 

Erythema. Redness of the skin; 
blushing. 

Eucalyptus. An Australian gum 
tree from which is obtained an oil 
used in medicine. This oil produces 
sweating, is tonic, stimulant, and anti- 
septic. 

Eustachian catheter. A tubular 
instrument designed to pass through 
the nasal cavity to the opening of the 
Eustachian tube. This latter is a canal 
leading from the back of the mouth to 
the middle ear. 

Evaporation. Loss of water by 
the action of heat. 

Excretions. Products of body 
waste; urine. 

External jugular vein. The larg- 
est superficial vein in the neck, run- 
ning downward midway upon both 
sides. 



Fallopian tubes. Two trumpet- 
shaped pipes, each about four inches 
long, connecting the womb with the 
abdominal cavity, through which ova 
pass. 

Fascia. Strong, glistening fibrous 
sheaths separating muscles. 

Feces. Body and food waste from 
the bowels. 
19 



Fermentation. The change ef- 
fected by the action of a ferment; 
souring. 

Fetus. A young child within or 
taken from its mother's womb before 
it has fully developed. 

Fibrils. Thread-like connective 
tissue. 

Fibrin. Fine elastic strands formed 
during clotting and inflammation. 

Fibrin -ferment. A substance 

causing the formation of fibrin. 

Fistulse. Disease tracts indisposed 
to heal. 

Flacherie. A contagious disease 
of silkworms caused by micrococci. 

Flat wines. Wines spoiled by 
begin ning acid fermentation. 

Flatulence. Excess of gas in the 
stomach or bowels; wind colic. 

Fuller's earth. A finely powdered 
earth used as an absorbent. 

Fumigate. To free from infection 
by the use of vapors. 

Fungi. The lowest order of non- 
flowering plants living upon animal 
matter; in bacteriology, a micro-organ- 
ismal moss. 

G. 

Gangrene. Local death of the 
part. 

Germ theory. The theory that all 
specific disease is due to the presence 
or action of micro-organisms. 

Germicidal solution. A germ 
killer. 

Glanders. A disease of horses 
caused by the bacillus mallei which 
affects the air-passages and skin and 
is transmissible to man. 

Globulins. A form of albumin. 

Gonococcus. The germ that 

causes the venereal disease called 



290 



GLOSSARY. 



gonorrhea; consists of a double, 
dumbbell coccus. 

Gonorrhea. A sexual disease 
caused by the transfer and activity 
of a germ called the gonococcus 
from one individual to another. 

Granulation tissue. Reddish, bud- 
like projections found upon the sur- 
face of a healing wound. 

Gynecologic. Relating to the 
sexual organs of a woman. 



Heart paralysis. A condition in 
which the heart's action is rapidly 
weakened or ceases. 

Hemorrhage. Bleeding; generally 
used to designate a profuse loss of 
blood from the vessel affected. 

Hemorrhoids. Dilated and elon- 
gated blood-vessels about the open- 
ing of the lower bowel; piles. 

Hernia. An abnormal protrusion 
of an organ or tissue. 

High enemata. An injection made 
high into the bowel by aid of gravity 
and a rectal tube. 

Hives. Common name for a skin 
disease giving rise to an evanescent 
eruption associated with severe itching. 

Hydrophobia. A disease of dogs 
and kindred animals communicated 
to man by direct inoculation; rabies. 

Hypodermic injection. Deposit 
of a solid or fluid beneath the skin 
by means of a syringe and hollow 
needle. 

Hypostasis. The settling of blood 
or fluid to the lowest parts of the body 
by gravitation after death, or loss lof 
pressure-controlling power in a given 
set of blood-vessels. 

Hysterectomy. Removal of the 
womb by operation. 



I. 



Icterus. Bile-stained; jaundiced. 

Immunity. A condition in which 
a body resists the development of 
micro-organisms or the action of their 
poisons. 

Immunizing unit. A standard 
strength agent to subdue the powers 
of a given quantity of micro-organ- 
isms or their products. 

Infectious disease. One capable 
of being transmitted from one person 
to another. 

Infective. Likely to produce dis- 
ease. 

Infective puerperal endometritis. 
Purulent inflammation of the lining 
of the womb after childbirth. 

Inflammation. Reaction of a part 
to an irritant. 

Infusion. Charging the veins with 
fluid by injection. 

Inoculation. The act of directly 
implanting disease. 

Inoculous. Rendered sterile. 

Insomnia. Unable to sleep. 

Inspissated. Dried and thickened 
from loss of water. 

Intestinal adhesion. Union of 
two peritoneal surfaces of the bowel 
caused by inflammatory action. 

Intestines. The bowels. 

Intracerebral injection. Deposit 
within the cavities of the brain. 

Intravenous. Within the veins. 

Intravenous injection. An injec- 
tion forced directly into a vein or 
cellular tissue. 

Intubation. Operation of passing 
a tube through the larynx when closed 
by disease, as in diphtheria. 

Isolation. Setting apart from all 
communication with others. 



GLOSSARY, 



291 



Knuckle of intestine. A short 
length of gut sharply bent upon 
itself. 

Kraske's operation. Operation 
devised by the surgeon whose name 
it bears for the removal of cancer 
growing high up in the rectum. The 
diseased area is exposed by chiselling 
away the coccyx and portions of the 
sacrum. 

L. 

Lanolin. A bland, fatty substance 
prepared from sheep's wool and used 
as the base of many ointments. 

Laparotomy sheet. Linen sheet 
covering containing a longitudinal 
opening through which patient's ab- 
domen is exposed. 

Lavage. Washing by irrigation. 

Leprosy. A chronic obscurely 
contagious disease caused by the 
bacillus of leprosy, and giving rise 
to various inflammatory lesions of 
the skin and internal organs. 

Leprous nodules. One form of 
skin lesion caused by leprosy con- 
sisting of firm, irregular elevations, 
which later break down and become 
ulcers. 

Leukocytes. Unit masses of pro- 
toplasm or the physical life principle. 

Ligation. The tying off of blood- 
vessels, the ovarian tubes, the appen- 
dix, or a tumor by means of a gut or 
silk string. 

Liquefied. Changed from a soHd 
to a liquid state. 

Lister ism. Antiseptic surgery ac- 
cording to the principles first laid 
down by Sir Joseph Lister. 

Litholapaxy. The operation of 



removal of stone from the bladder 
by crushing and washing out the frag- 
ments. 

Lithotomy. The operation of cut- 
ting for stone. 

Lithotrite. An instrument for 
crushing stones within the bladder. 

Lubricant. A substance used to 
diminish friction; rendering slippery. 

Lymphatic vessels and glands. 
The great system of absorbents with 
their connecting channels. 



M. 

Malady. Sickness, disease. 

Malignant tumor. One which has 
undergone cancerous change. 

Masticated. Chewed. 

Meatus. Anatomical name for the 
mouth of a canal. 

Media. The means of transmis- 
sion; substances favorable for the 
growth of bacteria. 

Mediastinum. The middle space 
of the chest cavity between the lungs, 
and containing the heart and great 
blood-vessels. 

Medicaments. Medicines. 

Menstruum, A fluid carrier or 
solvent for a drug. 

Miasm. Infection carried in the 
emanations from the soil. 

Miasmatic. Caused by infectious 
particles rising in vapors from the soil; 
said of malaria before its cause was 
known. 

Micrococci. Germs having a 

spherical shape. 

Micro-organisms. Any form of 
germ life. 

Minim. A fluid drop. 

Monomorphous. Having but one 
form. 



292 



GLOSSARY. 



N. 

Narcotized. Poisoned by the action 
of a narcotic, as opium. 
Natural rhythm of respiration. 

Normal breathing. 

Nerve -center. One of the count- 
less impulse generators or reflectors 
in the body. 

Neutralization. The act of ren- 
dering free or open. 

Nidus. Center of activity. 

Nutrient. Having food value. 



Occlusion. Closing up. 

Ophthalmic. Relating to the eye. 

Organic ferment. The microbic 
action vi^hich gives rise to souring. 

Organized exudate. A fluid dis- 
charge made solid by the formation 
of fibrin. 

Otitis media. Inflammation of 
the chambers of the middle ear. 

Ova. Eggs. 

Ovaries. The tw^o egg-bearing 
organs in the female. 

Oxidation. Burning up. 

Oxygenation of the blood. Re- 
freshing of the blood by the action of 
the red cells in taking up oxygen. 



Parasitic organisms. Dependent 
upon other forms of life for their 
food; may live in or upon the sustain- 
ing organism. Gonococci are para- 
sites, as are also tapevi^orms and lice. 

Pasteur chamber and filter. An 
apparatus for sterilizing and filtering 
by the action of superheated steam, 
varied in pressure by means of an air- 
pump. 



Pathogenic bacteria. Disease 
producers. 

Pathologist. One engaged in the 
study of the causes and results of dis- 
ease. 

Pebrin. A hereditary contagious 
disease of silkworms consisting of the 
development of peculiar parasitic cor- 
puscles which invade the eggs, blood, 
and tissues of the worms, causing 
black spots to appear externally. 

Pedicle. An elongated support. 

Pedicle silk. Strong silk used to 
tie off the base of tumors before re- 
moval for security against bleeding. 

Pellicle. Surface scum; an outer 
limiting membrane. 

Pelvic cavity. Space within the 
pelvis. 

Pelvimeter. Curved dividers used 
by the obstetrician in calculating the 
size of a woman's pelvis. 

Pelvis. The bony framework at 
the base of the spinal column sup- 
porting the trunk and affording at- 
tachment for the thighs. 

Perforator. A sharp, spear-headed 
instrument used by obstetricians to 
pierce the skull (to facilitate dehvery) 
of a dead infant or one whose life 
must be sacrificed for the good of the 
mother. 

Perineal lithotomy. The breech 
operation of cutting for stone. 

Perineorrhaphy. The operation 
of sewing up a torn breech of a 
woman. 

Peristalsis. The muscular wave- 
motion of the bowels. 

Peristaltic action. The motion 
which propels the contents of the 
bowels. 

Peritoneal cavity. The space oc- 
cupied by the abdominal organs. 

Peritoneum. The lining mem- 



GLOSSARY. 



293 



brane of the belly cavity and cover- 
ing of the organs contained. 

Peritonitis. Inflammation of the 
lining membrane of the organs and 
cavity of the abdomen. 

Petri dishes. Small double dishes 
for the cultivation of micro-organ- 
isms. 

Phagocytes. Body cells whose sup- 
posed function is to devour other cells 
as micro-organisms. 

Phagocytosis. The function of 
active destruction by devouring or 
englobing of one cell by another. 

Pharyngeal paralysis. Loss of 
voluntary power of swallowing, with 
dropping of the soft palate. 

Placenta. The late womb con- 
nection between a fetus and its 
mother. 

Plague. An acute contagious dis- 
ease commonly appearing in epidemic 
form due to micro-organisms char- 
acterized by bubo formation and high 
death-rate. 

Plasma. The fluid portion of 
blood or lymph. 

Pleurisy. Inflammation of the 
pleura or membranous covering of the 
lungs and lining of the chest walls. 

Pneumonia. Inflammation of the 
lungs. 

Precipitated. Thrown down by 
chemical action. 

Preparatory treatment. Mak- 
ing a patient ready for an operation, 
consists in local cleansing, attention 
to bowels and bladder, food, etc. 

Prone. Lying upon the abdomen. 

Prophylaxis. Preventive meas- 
ures. 

Protective dressing. A water- 
proof material placed next to a 
wound according to the direction of 
Sir Joseph Lister. 



Puerperal. Relating to child- 
birth. 

Puerperal fever. Elevation of 
body temperature occurring in infec- 
tion after childbirth. 

Puerperal infection. Systemic 
poisoning by the action of micro- 
organisms in a child-bearing woman. 

Pure culttire. Containing but one 
variety of germs. 

Purgative. A substance which 
moves the bowels. 

Pus. Matter given off from an 
open sore. 

Putrefaction. Separation of an 
organic compound into the elements 
of which it is composed by the action 
of micro-organisms; rotting. 

Pyroxylin. Gun-cotton; made by 
immersing raw cotton in nitric and 
sulphuric acids. 



R. 



Raw surface. An open wound or 
abrasion; a condition in which the skin 
or outer lining of a part or organ is 
broken through. 

Reaction. The restoration of vital- 
ity after shock. 

Rectum. The lower extremity of 
the large intestine. 

Recurrent. Returning again. 

Regurgitation. A back flow. 

Respiration. Breathing. 

Retention of urine. That condi- 
tion in which the urine, while it con- 
tinues to be formed by the kidneys, 
cannot be passed from the body; in- 
ability to pass water. 

Revulsion. A rejection; counter- 
irritation. 

Rigor. Sense of coldness accom- 
panied by a superficial convulsive 



294 



GLOSSARY. 



s. 



Salicylated. Containing a given 
amount of salicylic acid. 

Saliva. Spittle. 

Saprophytic organisms. Those 
living in or on decaying organic mat- 
ter. 

Sarcoma. A form of cancer of 
rapid growth and occurring most 
often in the young. 

Saturated. Fully filled; soaked. 

Scapula. The shoulder-blade. 

Scarify. To cut into. 

Scarlet fever. An acute conta- 
gious disease of childhood giving rise 
to high fever, rapid pulse, a rose-red 
rash, and with a marked tendency to 
be followed by kidney disease. 

Scultetus bandage. An over- 
lapping many-tailed bandage dress- 
ing. 

Secretions. Special substances 
thrown off by functionally active 
organs. 

Sedative. Soothing; softening. 

Septic. Relating to putrefaction 
or pus-germ infection. 

Septic discharge. Purulent; con- 
taining pus germs. 

Septic peritonitis. Inflammation 
of the lining membrane of the organs 
and cavity of the abdomen caused by 
the action of pus germs. 

Septicemia. A severe form of 
blood-poisoning in which both germs 
and their products are current in the 
blood. 

Sequelae. After-effects of dis- 
ease. 

Sequestrum. A dead mass, as a 
fragment of a dead bone. 

Serum. The watery part of drawn 
blood separating on standing; the fluid 
in a blister. 



Shock. The constitutional effect 
of a disease or injury. 

Sinus. A disease tract or channel 
left after the discharge of a purulent 
collection. 

Specific bacteria. Germs directly 
responsible for the given disease. 

Sphincter muscle. Anatomical 
name for muscles whose actions are 
to close openings, as at the mouth 
and anus. 

Spica. A spiral bandage done 
with a roller in a series of figure 
eights. Most used for the shoulder, 
groin, thumb, and great toe. 

Spirilla. Spiral-shaped germs, as 
the spirillum of cholera (also called 
the comma bacillus). 

Splenic fever. Disease due to the 
anthrax bacillus; wool-sorter's dis- 
ease. 

Spore. A germ seed. 

Spotted fever. Epidemic cerebro- 
spinal meningitis or cerebrospinal 
fever; a specific infectious disease of 
the membranes of the brain and spinal 
cord and accompanied by a peculiar 
dusky rash. 

Sterilization. Act of rendering 
free from germs. 

Sterilize. To kill all germ Hfe. 

Stethoscope. An instrument for 
listening to the flow of air or blood 
inside the body. 

Stimulation. Arousing to greater 
action; urging. 

Subcutaneous injection. One 
made beneath the skin. 

Subnormal temperature. Degree 
of body heat below g8° F. 

Supine. Outstretched upon the 
back. 

Suppression of urine. A condi- 
tion in which the kidneys cease to 
act, no urine being formed. 



GL OSSAR Y. 



295 



Suppuration. The last stage of 
inflammation, manifested by destruc- 
tion of tissue with pus formation. 

Suprapubic lithotomy. Cutting 
operation for stone in the bladder 
attacked from above. 

Surgically clean. As nearly as is 
possible to be free from germ life. 

Sutures. The material with which 
a surgeon sews; the stitches them- 
selves. 

Syncope. Sudden loss of power 
and consciousness; fainting. 

T. 

Tampon. A gauze or cotton plug; 
may have a string or tape attached 
for withdrawal. 

Technic. The mode of working; 
plan or method of work. 

Tepid. Moderately warm. 

Tetanus. Lockjaw; a very dan- 
gerous germ disease characterized by 
locking of sets of muscles due to the 
presence of a poison developed by 
tetanus bacilli. 

Therapeutics. The science of the 
application of medicines for the cure 
of diseases. 

Thoracic cavity. The chest. 

Toxicity. Degree of poison. 

Toxin. Poison formed by germ 
Hfe. 

Trachelorrhaphy. Operation for 
the repair of a torn mouth of the 
womb. 

Tracheotomy. Operation of cut- 
ting open the windpipe below the 
larynx for the purpose of admitting 
air to the fungs; done for closure of the 
upper air-passages. 

Traumatic delirium. Brain ex- 
citement following serious body in- 
jury. 



Trikresol. A refined mixture 
made from carbolic acid. 

Tubercles. Local efiects of the 
action of tubercle bacilli consisting 
of cheesy masses. 

Tuberculosis. An infectious dis- 
ease giving rise to general or local 
disorganization caused by the tuber- 
cle bacillus; consumption. 

Tumefaction. A sweUing. 

Turpentine stupe. A piece of 
cloth or flannel dipped in spirits of 
turpentine after wringing out in hot 
water. 

Tympanites. Distention of the 
abdomen caused by excess of gas in 
the stomach and bowels; may become 
drum-like. 

u. 

Ulcer. A sore, attended by dis- 
charge. 

Ulceration. Superficial death of 
a part. 

Ulcerative endocarditis. A severe 
inflammation of the heart, ending 
with destruction of the valve leaflets. 

Undertaker's stretcher. A port- 
able board and trestle inclined table 
upon which a corpse is laid during 
the process of embalming. 

Uremic coma. Loss of conscious- 
ness and physical condition following 
the absorption of urinary poisons 
in the late stages of kidney dis- 
ease. 

Ureter. The tube leading from 
the kidney to the bladder. It is of 
the diameter of a goose quill and 
about sixteen inches in length. 

Urethra, The water pipe from 
the bladder. 

Urethral calibrator. An instru- 
ment for determining the size of the 
canal. 



296 



GLOSSARY, 



Urination. The act of passing 
water. 

Uterine appendages. The ovaries, 
Fallopian tubes, broad and other at- 
taching ligaments of the womb. 

Uterus. The womb; the hollow, 
pear-shaped pelvic organ which is 
destined to retain the child from the 
moment of its conception until the 
time of its expulsion at birth. 



V. 

Vaccination. Inoculation of cow- 
pox lymph into the arm as a protec- 
tion from small-pox. 

Vacuum. Space in which there is 
no air. 

Vagina. The female genital canal. 

Vaginal discharge. A flow from 
the genital canal. 

Vaginal hysterectomy. Removal 
of the womb through the lower gen- 
ital canal. 

Vascular. Pertaining to vessels. 



Venesection. Bleeding; opening 
a vein to let out blood. 

Venom. Animal poison. 

Venous pressure. The weight 
and flow power of the blood stream 
in the veins. 

Venules. Smallest branching veins. 

Vertex. The crown of the head; 
highest point of the skull. 

Vestibule. The beginning of the 
female genital canal. 

Virulence. Poison-strength. 

Virulent. Highly poisonous; de- 
structive. 

Virus. Any form of organic poison. 

Viscera. The contents of the large 
cavities of the body. 

Viscosity. Stickiness. 

Vulva. The external genitals, pri- 
vate parts, the female external organs 
of generation. 

w. 

Wound drainage. A method of 
providing for the escape of pus or 
serum drip from a wound. 



INDEX 



Abdominal bandage, 76 

cavity, apparatus for douch- 
ing, 1 55 
operations, 241 

instruments for, 108 
Abscess, stitch-, 163 
Absorbent cotton, 147, 165 
Accidents during operation, 238 
Acclimatization immunity, 32 
Acid, carbolic, treatment after 
poisoning by, 194 | 

hydrocyanic, treatment after 
poisoning by, 194 
Acids, mineral, treatment after 

poisoning by, 194 
Aconite poisoning, 194 
Acquired immunity, 32 
Actinomycosis, communication 

of, to man, 14 
Adenoid forceps, 122 
Adhesive plaster, rubber, 150 
After-care for gynecologic opera- 
tions, 263 
Albumin water, 265 
Alcohol as an antiseptic, 59 

sterilization of hands with, 59 
Allis's aseptic ether-inhaler, 135 
Ambulance, transportation by, 

212 
Ammonia, subcutaneous injec- 
tion of, as test in supposed 
death, 273 
Amputation of limb, instru- 
ments for, 116 
Anastomosis button of Murphy, 

III 
Anesthesia, 130-146 
bronchorrhea in, 136 
dilated pupils in, 138 
general, instruments for, 103 



Anesthesia, infiltration, 144 
instruments for, 103 
local, instruments for, 103 
preparation for accidents in, 

134 
primary, 138 
vomiting during production of, 

137 
Anesthetics, administration of, 
130 
chloroform, 140 
cocain, 144 

ether, administration of, 134 
ethyl bromid, 141 
general, 130 
local, 130, 142 
cocain, 142 

hydrochlorate, 143 
ethyl chlorid, 143 
eucain, 142 
ice, 142 

phenate of cocain, 143 
orthoform, 63 
hydrochlorid, 63 
Schleich's, 142 
Anesthetizing stethoscope of 

Griffith, 137 
Aneurysm needle, 113 
Angiotribe of Tuffier, 1 1 1 
Anthrax, discovery of bacterial 

nature of, 15, 16 
Antidotes, 194-196 
Antimony tartrate poisoning, 194 
Antiseptic douches, 181 
dressings, 147 
powders, 151 

surgery. Lister's system, 12, 13 
Antiseptics, 44-64 
alcohol, 59 
aristol, 57 

297 



298 



INDEX, 



Antiseptics, balsam of Peru, 63 
boiling water, 47 
boric acid, 58 
boroglycerid, 59 
carbolic acid, 50 
chlorin, 49 
chlorinated lime, 61 
coal-tar derivatives, 50 
Condy's fluid, 61 
corrosive sublimate, 49 
creolin, 52 

crude carbolic acid, 51 
dermatol, 64 
formaldehyd, 54 
heat, 47 

moist, 47 
hot air, 48 

hydrochloric acid, 62 
hydrogen peroxid, 58 
ichthyol, 62 
iodoform, 53 
iodol, 54 

Labarraque's solution, 61 
listerine, 64 
lysol, 52 
methyl-blue, 61 
methyl-violet, 61 
milk of lime, 62 
mustard, 64 
normal salt solution, 63 
orthoform, 63 

hydrochlorid, 63 
oxalic acid, 60 
ozone, 48 

potassium permanganate, 60 
protargol, 64 
pyoktanin, 61 
resorcin, 64 
saprol, 53 
soaps, 65 

sodium bicarbonate, 64 
sozal, 53 
steam, 47 

live, 48 
sulphur dioxid, 49 
sulphuric acid, 62 
thymol iodid, 57 
vinegar, sterilized, 63 
zinc chlorid, 62 
Antistreptococcic serum for sep- 
tic peritonitis, 236 



Antitoxin, administration of, fol- 
lowed by stimulation of 
body's germicidal powers, 41 
in therapeutic practice, 37 
method of injecting, 43 
mixture of Coley for tumors, 

42 
of diphtheria, preparation of, 

38 
status of, 41 
streptococcus, 42 

preparation of, 39 
tetanus, 42 
theory of, 37 

of immunity, 34 
therapeutic action of, 39 
tuberculosis, 43 
preparation of, 39 
Antityphoid fever serum, 43 
Apple water, 265 
Aristol, 57 
Arnold sterilizer, 90 
Arrowroot gruel, 267 
Arsenic poisoning, 194 
Artificial immunity, 33 
respiration, 230 

Schultze's method, 201 
Sylvester's method, 231 
Asepsis in gynecologic opera- 
tions, 254 
Atropin poisoning, 194 
Autopsies, 274 
cleanliness in, 277 
instruments, etc., for, 276 
preparation of body for, 275 
time for, 275 



BacilI/US, 21 

aerogenes capsulatus, 36 
coli communis, 35 
comma, discovery of, 17 
diphtherige, 36 

discovery of, 17 
effect of light on, 47 
icteroides, discovery of, 18 
melitensis, discovery of, 19 
of bubonic plague, discovery 

of, 18 
of glanders, discovery of, 17 
of influenza, discovery of, 18 



INDEX. 



299 



Bacillus of leprosy, discovery of, 
16 
of Malta fever, discovery of, 19 
of measles, discovery of, 18 
of tetanus, 36 

discovery of, 17 
of yellow fever, discovery of, 

18 
pyocyaneus, 36 
tuberculosis, 36 

discovery of, 17 
typhosus, discovery of, 16 
Bacteria, 20 

as causes of disease, 20 
channels of entrance into body, 

27, 28 
conditions influencing growth 

of, 26 
disease-producing, 46 
distribution of, 9 
entrance of, through alimen- 
tary canal, 28 

through respiratory tract, 28 

through skin, 27 
forms of, 21 

Koch's circuit to prove spe- 
cific pathogenic powers of, 

29 
pyogenic, 22, 
reproduction of, 25 

by binary division, 25 

by fission, 25 

by sporulation, 25 
sizes of, 20, 21 
Bacteriology, 9 
history of, 9 
progress of, 1 1 
Balsam of Peru, 63 
Bandage, abdominal, 76 
Barton's, 68 
breast, 71 
chest, 70 
Desault, 75 
elbow, 73 
eye, 81 

fingers, 71, 72 
foot, 78 

for securing lithotomy posi- 
tion, 81 
four-tailed, of jaw, 69 
Gibson's, 69 



Bandage, Griffith's, of head, 69 

groin, 76, 77 

hand, 71 

handkerchief, 69 

head, 67 

knee, 77, 78 

leg, 79 

lower extremity, 76 

neck, 70 

penis, 80 

perineal binder, 81 

Pryor, 77 

recurrent, of stump, 80 

Scultetus, 82 

shoulder, 74 

T-, 83 

thumb, 72 

upper extremity, 71 

Velpeau, 74 
Bandaging, 66 
Barley gruel, 268 

water, 266 
Barton's bandage, 68 
Basin, pus, 94 
Bath thermometer, 180 
Baudelocque-Osiander pelvime- 
ter, 115 
Bazzi-Bianchi's phonendoscope, 

273 

Bed for private operations, 246 

Bed-grapple of Griffith, 226 

Beef broth, 271 
essence, 270 

Belladonna, treatment after poi- 
soning by, 194 

Bellocq's canula, 233 

Bicarbonate of sodium, 64 

Bichlorid gauze, 148 

Bier's air-suction apparatus for 
stiff knee, 175 
vacuum treatment apparatus 
for boils, 175 

Bigelow's evacuator, 128 

Binary division of bacteria, 25 

Bismuth gauze, 149 

Bladder, attention to, after oper- 
ations, 221 
irrigation of, 178 
operations on, instruments for, 
126 

Boiled rice, 269 



300 



INDEX, 



Boiling water as germicide, 47 

Boils, Bier's vacuum treatment, 
apparatus for, 175 

Bone-cutting forceps, 112 
of DeVilbiss, 113 

Boric acid, 58 

Boroglycerid, 59 

Bowels, attention to, after opera- 
tions, 221 

Brain, operations on, instru- 
ments for, 114 

Braun's cranioclast, 113 

Breast, bandage of, 71 

Breast-binder, Murphy's, 200 

Breast -pump, 115 

Bremer's ureter-cystoscope, 122 

Bronchorrhea in anesthesia, 136 

Broth, beef, 271 
chicken, 271 
juice, 271 
mutton, 271 

Brush, electric, 193 

Brushes, 166 

Bubonic plague, bacillus of, dis- 
covery of, 18 

Bulb-syringe, 250 

Button, Murphy's, iii 

Button-suture, 162 



Cadaveric lividity, 274 
Cantharides poisoning, 194 
Canton-flannel legging, 127 

roll for instruments, 100 
Canula, Bellocq's, 233 
Capsule forceps, 123 
Carbolic acid, crude, 51 
Cargile membrane, 170 
Cataract knife, 123 
Catgut, 158 

bichlorid, 160 

iodized, 160 

preparation of, 158 

sterilization of, 158 
with formalin, 161 
Catheter, Eustachian, 112 

Gouley's, 127 

Skene's, 105 
Catheterization, 176 
Catheters, 176 

glass, 176 



Catheters, introduction of, 177 
Catlin, 115 

Cautery, Paquelin, 152 
Cerebrospinal meningitis, epi- 
demic, specific germ as cause 

of, 19 
Cervix, dilatation of, instru- 
ments for, 108 
Chain-saw of Gigli, 113 
Charts, keeping of, 97 

medical, 102 
Chest, bandage of, 70 
Chicken broth, 271 
Chicken-cholera, 16 
Chlorinated lime, 61 
Chlorin, 49 

Chlorin-water poisoning, 195 
Chloroform, 140 

inhaler, Griffith's, 140 

poisoning, 195 
Cholera, chicken, 16 
Cigarette drain, 167 
Circulation, absence of, as sign of 

death, 272 
Coal-tar derivatives, 50 
Coaptation splint, 84 
Cocain, 142 

anesthesia, 144 

hydrochlorate, 143 

phenate, 143 

poisoning, 145 
Cocainization, spinal, 145 
Cocci, 21 

morphology of, 23 
Colchicum poisoning, 195 
Cold, application of, 189 

dry, application of, 189 

moist, application of, 189 

use of, 188 
Coley's antitoxin mixture for 

tumors, 42 
Collodion dressing, 149, 192 
Comma bacillus, discovery of, 17 
Compresses,, 85 
Condy's fluid, 61 
Conium poisoning, 195 
Continuous suture, 162 
Copper sulphate poisoning, 195 
Cornstarch, 270 
Corrosive sublimate, 49 
poisoning, 195 



INDEX, 



301 



Corrosive sublimate, swallowing 

of, 50 
Cotton, 192 

absorbent, 147, 165 

applicators, 112 
Counterirritation, 187 
Cracker gruel, 268 
Cranioclast, Braun's, 113 
Creolin, 52 

Croton-oil poisoning, 195 
Cupping, dry, 190 

wet, 191 
Curet, sharp, 107 

spoon, 106 

steel-eyed, 121 
Currant juice, 266 
Cystoscopic examination, instru- 
ments for, 129 
Cystotome, 123 
Cysts or tumors, instruments for, 

114 

Dam, rubber, 170 
Death, signs of, 272 

absence of circulation, 272 
of heart beat, 272 
of respiration, 272, 273 
hypostasis, 274 
insertion of needle, 274 
rigor mortis, 274 
subcutaneous injection of 

ammonia, 273 
temperature, 274 
stiffness of, 274 
Delirium, traumatic, from shock, 

232 
Deodorants, 44 
Dependent pockets, 167 
Dermatol, 64 
Desault bandage, 75 
DeVilbiss bone-cutting forceps, 

113 
trephine, 124 

Diet after operations, 222, 226 
gynecologic, 264 
milk, 266 
of labor, 199 
recipes, 265 

Digitalis poisoning, 195 

Diphtheria antitoxin, prepara- 
tion of, 38 



Diphtheria antitoxin, status of, 

41 

bacillus of, 36 
discovery of, 17 
Diplococci, 23 
Diplococcus pneumoniae, 36 
Director, Griffith's, 127 
Disease, bacteria as causes of, 20 

conditions necessary for causa- 
tion of, 29 

in man, fungi connected with, 
21 
Disinfectants, 44 
Disinfection, 46 

by steam, 48 ' 

Dorsal position, 256 
Douche-board, 182 
Douche-pan, 181 
Douches, 180 

administration of, 180 

antiseptic, 181 

vaginal, apparatus for, 181 
Douching abdominal cavity, ap- 
paratus for, 155 
Drain, cigarette, 167 
Drainage, 166 

postural, 168 
Drainage-tubes, care of, 168 

glass, 166, 169 

rubber, preparation of, 169 
Dressing-rooms, 87 
Dressing-table, 218 
Dressings, 66 

antiseptic, 147 

collodion, 149, 192 

surgical, 147 
Dust, infection from, in opera- 
tions, 209-211 



Ear, operations on, 239 
instruments for, 118 

specula, 124 

syringe, 240 
Kdebohl's dorsal posture, 256 
Effervescing lemonade, 266 
Egg lemonade, 266 
Eggs, 268 

poached, 269 

scrambled, 269 

shirred, 269 



302 



INDEX, 



Elaterium, poisoning by, 195 
Elbow, bandage of, 73 
Electric brush, 193 
Electricity, 193 
Electrolysis, 193 

needles, 193 
Elevator, periosteal, 112 
Emergency bundles, 166 

operations, preparations in, 
251, 252 
Emulsion of iodoform, 148 
Enema, 183, 184 
for tympanites, 184 
purgative, 184 
stimulating, 184 
Enteroclysis, 182 
Esmarch's tourniquet, 232 
Ether, administration of, 134 
nausea after, 139 
to children, 138 
vomiting after, 139 
death from, 139 
Ether-inhaler, Allis's, 135 
Ethyl bromid, 141 
chlorid, 143 

mask and tube for, 140 
Eucain, 142 

Eustachian catheter, 112 
Evacuator, Bigelow's, 128 
Examinations, gynecologic, 254, 
255. See also Gynecologic 
examinations. 
of rectum, 258 
Excretions, disinfectants for, 62 
Extremities, operations on, 241 
Eye, bandage of, 81 
operations on, 239 
instruments for, 118 
Eyelid speculum, 120 



Fermentation-feve;r, 236 
Finger cots, 171 
Fingers, bandage of, 71, 72 
Fish poisoning, 196 
Fission, 25, 26 
Flaxseed tea, 267 
Flour ball, 268 
Foot, bandage of, 78 
Forceps, adenoid, 122 
bone-cutting, 112 



Forceps, bone-cutting, of DeVil- 
biss, 113 

capsule, 123 

hemostatic, varieties of, 109 

phimosis, 122 

septum, 119 

tracheotomy, 121 
Formaldehyd, 54 

as dusting-powder, 55 

generator, 56 

inhalation of, 56 

sterilization of instruments and 
dressings with, 91 
Formalin lamp, 90 

poisoning, 56 

sterilization of catgut with, 
161 
Fountain-syringe, 250 
Four-tailed bandage, 69 
Fowler's position in peritonitis, 

168 
Fracture-box, 85 
Fractures, 242 
Fungi connected with disease in 



Gant's pile-clamp, 128 
Gas and liquid anesthesia, inhaler 
for, 145 

nitrous-oxid, portable appara- 
tus for, 131 
Gauze, 147, 165 

bichlorid, 148 

bismuth, 149 

iodoform, 148 

packer, 107 

pads, 164 

potassium permanganate, 149 

requirements of, for dressings, 

147 
Genupectoral position, 257 
Germicides, 44 

Germs, incubation-period of, 31 
Gibson's bandage for jaw, 69 
Gigli's chain-saw, 113 
Girdle, Neptune, 139 
Glanders, bacillus of, discovery 

of, 17 
Glass hand bowl, 94 

instrument tray, 93 



INDEX. 



303 



Glover's suture, 162 
Gloves, 170 
rubber, 170 

solution for, 171 
Glycerin, sterilization of, 165 
Gonococcus as cause of gonor- 
rhea, 16 
discovery of, 16 
Gonorrhea, gonococcus of, 16 
Gouley's tunneled catheter, 127 
Gram's method of staining strep- 
tococcus, 24 
Green soap, 172 

Griffith's antiseptic irrigator tip 
holder, iii 
bed-grapple, 226 
combined inhaler for gas and 

liquid anesthesia, 145 
director, 127 
head bandage, 69 
hook for use in glass-shelved 

instrument cases, 87 
membrane, 170 
one-piece wooden mallet, 124 
operating table-bed, 261 
single-eared anesthetizing 

stethoscope, 137 
wire-frame chloroform inhaler, 

140 
wooden mouth-wedge and gag, 

131 
Groin, bandage of, 76, 77 
Gruber's ear specula, 124 
Gruel, arrowroot, 267 

barley, 268 

cracker, 268 
Gynecologic examinations, 254, 

255 
asepsis in, 254 
positions in, 255 

dorsal, 256 

Edebohl's, 256 

genupectoral, 257 

knee-chest, 257 

latero-abdominal, 256 

lithotomy, 257 

Sims', 256 

Trendelenburg, 261 

upright, 255 

Walcher, 258 
preparations for, 259 



Gynecologic operations, 254. See 
also Operations, gyneco- 
logic. 
instruments for dressing 
after. 126 



Hand, bandage of, 71, 72 
bowl, glass, 94 

Handkerchief bandage, 69 

Hard-rubber oral screw, 131 

Head, bandage of, 67 
operations on, 239 

Heart-beat, absence of, value of, 
as sign of death, 272 

Heat, application of, 188 
dry, application of, 188 
germicidal powers of, 47 
moist, application of, 188 

as germicide, 47 
use of, 188 

Hemorrhage following opera- 
tions, 232 
symptoms, 233 
treatment, 233 

Hemostatic forceps, 109 

Hernia, 236 

Horsehair suture material, 162 

Horsley's wax, 150 

Hot air as germicide, 48 

Hot-air oven, 189 

House-stretcher, 88 

Hydrochloric acid as disinfect- 
ant, 62 

Hydrocyanic acid, poisoning by, 
194 

Hydrogen peroxid, 58 

Hydrophobia, first application of 
Pasteur's treatment, 18 

Hygiene of nurse, 278 

Hyoscyamus poisoning, 195 

Hypodermic injection, 186 
syringe, Luer's, 131 

Hypodermoclysis, apparatus for, 

154 
Hypostasis as sign of death, 274 
Hysterectomy, 238 

insanity after, 238 

vaginal, 238 

instruments for, 114 



304 



INDEX, 



Ice; as local anesthetic, 142 

Ice-bag, 174 

Ichthyol, 62 

Illuminating gas, poisoning by, 

195 
Immunity, 31 

acclimatization, 32 
acquired, 32 
antitoxin theory of, 34 
artificial, 33 
natural, 32 
racial, 32 
theories of, 32-34 
phagocytosis, 33 
Imperial drink, 266 
Incision, deep, 192 
Incubation -period of germs, 31 
Infant, new-born, 199. See also 

New-born infant. 
Infants, care of, 197 
Infection from dust in operations, 
209-211 
of sutures, 163 
Infiltration-anesthesia, 144 
Inflammation, 173 

causes of, 175 
Influenza, bacillus of, discovery 

of, 18 
Inhaler, Griffith's, for gas and 
liquid anesthesia, 145 
wire-frame chloroform, 140 
Injection of antitoxin, 43 
Injections, rectal, 182 
Insanity after hysterectomy, 238 
Instruments and dressings, steril- 
izer for, 91 
cabinet for, 86 
canton-flannel roll for, 100 
for anesthesia, 103 
general, 103 
local, 103 
for cystoscopic examination, 

129 
for dressing after gynecologic 

operations, 126 
for operations, 103-1 29 
abdominal, 108 
amputation of limb, 116 
curetting of uterus, 108 
cysts or tumors, 114 
dilatation of cervix, 108 



Instruments for operations on 
bladder, 126 
on brain, 114 
on ear, 118 
on eye, 118 
on mouth, 117 
on nose, 117 
on rectum, 125 
on spine, 114 
on throat, 117 
on urethra, 126 
perineorrhaphy, 103 
trachelorrhaphy, 104 
vaginal hysterectomy, 114 
obstetrical, 116 
sterilization of, 89 
apparatus for, 91 
with formaldehyd, 91 
sterilizing tube for, 90 
Instrument-trays, 93 

glass, 93 
Interrupted suture, 162 
Intestinal obstruction, 236 
lodin poisoning, 196 
Iodoform, 53 
emulsion, 148 
gauze, 148 
poisoning, 53 
lodol, 54 
Irrigation, 156 
of bladder, 178 
of rectum, 182 

of wound, apparatus lor, 156 
Irrigator, 215 



Johnson's method ior prepara- 
tion of catgut, 160 



Kangaroo-tendon, 157 
Kelly's leg-holder, 105 

pad, improvised, 248 
Keye's stone-searcher, 127 
Knee, bandage of, 77, 78 

stiff, Bier's air suction appara- 
tus for, 175 
Knee-chest position, 257 
Knife, cataract, 123 

for amputation, 115 

periosteum, 112 



INDEX. 



305 



Kny-Scheerer instrument cab- 
inet, 86 

Koch's circuit to prove specific 
pathogenic powers of microbe, 
29 

Koumyss, 267 

Labarraque's solution, 61 

Labor, diet of, 199 

nurse's duties after, 197 
before, 197 

Lamp, formalin, 90 

Lange's retractor, iii 

Latero-abdominal position, 256 

Lead salts, poisoning by, 196 

Leeching, 191 

Leg, bandage of, 79 
holder, 105 

Lemonade, 266 
effervescing, 266 
egg, 266 

Lens, wire loop for extraction of, 
123 

Leprous nodules, discovery of 
bacilli of, 16 

Liebreich's eye bandage, 81 

Ligature, 157. See also Sutures. 

Ligature-tray, Robb's aseptic, 94 

Light, effect of, on bacteria, 47 

Limb, amputation of, instru- 
ments for, 116 

Lime, chlorinated, 61 
milk of, 62 
water, 265 

Liniments, 190 

Listerine, 64 

Listerism, 13 

Lister's system of antiseptic sur- 
gery, 12, 13 

Lithotomy position, 249, 257 
bandage for securing, 81 

Lithotrite, 128 

Lobelia poisoning, 196 

Loring's ophthalmoscope, 123 

Luer's hypodermic syringe, 131 

Lysol, 52 

Malarial fever, cause of, 19 
Mallet, Griffith's, 124 
rawhide, 120 

20 



Malta fever, bacillus of, dis- 
covery of, 19 
Mareschal's vaccination stylet, 

189 
Mask and tube for ethyl chlorid, 

140 
Massage, 192 
Measles, bacillus of, discovery of, 

18 
Membrane, cargile, 170 

shark, 170 
Metal spoon, 123 

suturing clamps, 162 
Methyl-blue, 61 
Methyl- violet, 61 
Metschnikoff's theory of phago- 
cytosis, 34 
Micrococcus lanceolatus, 36 

Pasteuri, discovery of, 17 
Milk and cinnamon, 267 

diet, 266 

of lime, 62 

toast, 269 
Mineral acids, poisoning by, 194 
Minor surgery, 186 
Morphin poisoning, 196 
Mosquitoes as disseminators of 

yellow fever, 18 
Mouth, dryness of, after opera- 
tions, 220 

operation on, instruments for, 
117 
Mouth-gag, 122 
Mouth-wedge and gag, Griffith's, 

Murphy's anastomosmg button, 
III 
breast-binder, 2oo_ 
rubber-glove solution, 171 

Mustard as antiseptic, 64 

Mustard-plaster, 187 

Mutton broth, 271 



Nasal splint, 119 

syringe, 240 
Natural immunity, 32 
Nausea after etherization, 139 
Neck, bandage of, 70 

operations on, 240 
Needle, aneurysm, 113 



3o6 



INDEX. 



Needle-holder, Reiner's, 107 
Needles, 165 
electrolysis, 193 
insertion of, as test in sup- 
posed death, 274 
Neptune girdle, 139 
New-born infant, care of, 199 
clothing of, 200 
feeding of, 200 
nursing of, 199 
Nipple-shield, 115 
Nitrous-oxid gas, portable ap- 
paratus for, 131 
Nodules of leprosy, discovery of 

bacilli of, 16 
Nose, operations on, 239 
instruments for, 1 1 7 
Nurses, duties of, after labor, 197 
before labor, 197 
in operations, 204, 205, 216- 
220, 239-242 
hygiene of, 278 
personal conduct of, 278 
preparations of, for operations, 

205, 206 
rewards, success of, 278 
Nursing, obstetrical, 197 
Nux vomica poisoning, 196 



Obstetrical instruments and 
appliances, 116 

nursing, 197 
Obstruction, intestinal, 236 
Oils, sterilization of, 165 
Ointments, 190 
Operating table-bed, 261 
Operating-room, care of, 86 

preparation of, 204 
Operating-table, 237 

for private operations, 248 

portable, 244 
Operation blank, loi 
Operations, 203 

accidents during, 238 

arranging of patient for, 216 

attention to bladder after, 221 
to bowels after, 221 

care of patient after, 219-226 

diet after, 222-226 

dryness of mouth after, 220 



Operations, duties of nurses in, 
204, 205, 216-220, 239- 
242 
gynecologic, 254 
after-care, 263 
asepsis in, 254 
diet after, 264 
preparations for, 260 
hemorrhage after, 232. See 
also Hemorrhage following 
operations. 
infection in, from dust, 209- 

211 
in private practice, 243 
bed for, 246 
furniture, instruments, 

etc., for, 249 
operating-table for, 248 
preparations for, 244 
in emergency cases, 250, 

251 
sterilization of instru- 
ments for, 250 
of sheets, towels, etc., 
250 
instruments for, 103-129. See 
also Instruments for opera- 
tions. 
of election, 204 
of emergency, 204 
of expediency, 203 
of necessity, 204 
on abdomen, 241 
on ear, 239 
on extremities, 241 
on eye, 239 
on head, 239 
on neck, 240 
on nose, 239 
on thorax, 241 
on throat, 239 
pleurisy after, 219 
pneumonia after, 219 
preparation of field of, 213 
of vaginal canal, 214 
of nurses for, 205, 206 
of patient for, 212 

day before operation, 213 
day of operation, 215 
of surgeon and assistants for, 
207 



INDEX. 



307 



Operations, septic peritonitis 
after, 234. See also Peri- 
tonitis, septic, after opera- 
tions. 
sequelae of, 227 
shock after, 227. See also 

Shock following operations. 
special, 239 
thirst after, 220 
Ophthalmoscope, Loring's, 123 
Opium poisoning, 196 
Oral screw, hard-rubber, 131 
Orangeade, 266 
Orthoform, 63 

hydrochlorid, 63 
Oven, hot-air, 189 
Oxalic acid, 60 

poisoning, 196 
Ozone, 48 

Pads, gauze, 164 
Panado, 269 
Paquelin cautery, 152 
Parasites as cause of malignant 

tumors, 20 
Patient, arranging of, for opera- 
tions, 216 
care of, after operations, 219- 

226 
preparation of, for operations, 
212. See also Operations, 
preparation of patieiit for. 
transportation of, 212 
Pelvimeter, Baudelocque-Osian- 

der, 115 
Penis, bandage of, 80 
Perforator, Smellie's, 113 
Perineal binder for retaining 

dressings to perineum, 81 
Perineorrhaphy, instruments for, 

103 
Perineum bandage, 81 
Periosteal elevator, 1 1 2 
Periosteum knife, 112 
Peritonitis, Fowler's position in, 
168 
septic, after operations, 234 
symptoms, 234 
treatment, 235 

with antistreptococcic 
serum, 236 



Peroxid of hydrogen, 58 
Personal conduct of nurse, 278 
Phagocytosis theory of immun- 
ity, 32> 
Phenate of cocain, 143 
Phimosis forceps, 122 
Phonendoscope, Bazzi-Bianchi, 

273 
Phosphorus poisoning, 196 
Pile-clamp, Gant's, 128 
Plasmodium malariae as cause of 

malaria, 20 
Plaster, adhesive, rubber, 150 
Plasters, 192 

Pleurisy after operations, 219 
Pneumococcus, 36 

discovery of, 17 
Pneumonia after operations, 219 

croupous, bacillus of, 36 
Poached eggs, 269 
Poisons and antidotes, 194 
Politzer's inflating bag, 112 
Portable apparatus for nitrous- 
oxid gas, 131 

operating-table, 244 
Post-mortem rigidity, 274 
Potash salts, poisoning by, 196 
Potassium permanganate, 60 

gauze, 149 
Powder, antiseptic, 151 
Powder-blower, 121 
Private operations, 243. See 

also Operations in private prac- 
tice. 
Probang, 119 
Probes, 124 
Protargol, 64 

Pryor inguinal bandage, 77 
Puerperal fever, organic ferments 

as cause of, 14 
Pump, breast-, 115 
Puncturation, 192 

deep, 192 
Pupils, dilated, in anesthesia, 

138 
Purgative enemata, 184 
Pus, 174 

basin, 94 
Pushing lower jaw forward to 

prevent obstruction to breath- 
ing, 135 



3o8 



INDEX. 



Pyogenic bacteria, 23 
Pyoktanin, 61 
blue. 61 



Raciai^ immunity, 32 
Rawhide mallet, 120 
Recipes, diet, 265 
Rectal injections, 182 

speculums, 124 
Rectum, examination of, 258 
irrigation of, 182 
operations on, instruments for, 
125 
Reiner's needle-holder, 107 
Rennet, 269 
Resorcin, 64 

Respiration, absence of, as sign 
of death, 272 
value of, 272 
artificial, for shock following 
operations, 230 
Sylvester's method 
in, 231 
Schultze's method, 201 
Retractor, Lange's, iii 
sharp-pointed, 120 
Schroeder's, 109 
Rice, boiled, 269 

plain, 270 
Ridal speculum, 119 
Rigor mortis, 274 
Robb's aseptic ligature-tray, 94 
Robinson's douche-board, 181 
Rubber adhesive plaster, 150 
dam, 170 
drainage-tubes, preparation of, 

169 
gloves, 170 

solution for, 171 
heels, 280 
protective, 150 



Salt solution, normal, 153 

as antiseptic, 63 
Saprol, 53 
Sarcinae, 23 

Saw, chain-, of Gigli, 113 
Saws for amputation, 115 
Scarification, 191 



Schleich'3 anesthetic, 142 
Schroeder's vaginal retractor, 109 
Schultze's method of artificial 

respiration, 201 
Scissors, curved sharp-pointed, 

120 
Scrambled eggs, 269 
Screw, oral, 131 
Scultetus bandage, 83 
Septum forceps, 119 
Sequelae of operations, 227 
Serum, antityphoid fever, 43 
Shark membrane, 170 
Shirred eggs, 269 
Shock following operations, 227 
artificial respiration in, 

230 
symptoms, 229 
treatment, 229 

traumatic delirium from, 232 
Shotted suture, 162 
Shoulder, bandage of, 73, 74 
Signs of death, 274. See also 

Death, signs of. 
Silk, protective, oiled, 150 

sterilization of, 161 
Silkworm-gut, 158 
Silver nitrate poisoning, 196 

wire, 162 
Simpson's forceps, 115 

sound, 107 
Sims' position, 256 

speculum, 109 
Sinus, 237 

Skene's reflux catheter, 105 
Small-pox, vaccination for, 32 
Smellie's perforator, 113 
Snare, 106 
Soap, green, 172 
Soaps, 65 

Soda salts, poisoning by» 196 
Sodium bicarbonate, 64 
Solutions basin stand, 215 
Sound, Simpson's, 107 
Soup, invalid's, 270 

tapioca, 268 

toast, 267 
Sozal, 53 
Speculum, ear, 124 

eyelid, 120 

rectal, 124 



INDEX, 



309 



Speculum, Ridal, 119 

Sims', 109 
Spinal cocainization, 145 
Spine, operations on, instru- 
ments for, 114 
Spirillum, 21 

Splenic fever, discovery of bac- 
terial nature of, 15, 16 
Splints, 83 

coaptation, 84 

nasal, 119 
Sponges, 163 

gauze, 163 

marine, 163, 164 
Spoon curet, 106 

metal, 123 
Spores, resistance of, 26, 46 
Sporulation, 25 
Spotted fever, specific germ as 

cause of, 19 
Staining streptococcus. Gram's 

method, 24 
Staphylococci, 23, 24 
Staphylococcus epidermidis al- 
bus, 35 

pyogenes albus, 35 
aureus, 34 
citreus, 35 
Steam as germicide, 47 

disinfection by, 48 

live, as germicide, 48 
Stegomyia fasciata, 18 
Sterilization, 47, 89 

dry, 89 

fractional, 48 

intermittent, 48 

moist, 89 

of catgut, 158. See also Cat- 
gut. 

of glycerin, 165 

of hands with alcohol, 59 

of horsehair, 162 

of instruments, 90. See also 
Instruments, sterilization of. 

of oils, 165 

of sheets, towels, etc., for 
private operations, 249 

of silk, 161 
Sterilizer for instruments and 

dressings, 91 

improvised, 249 



Sterilizing outfit, 92 

tube for instruments, 90 
Stethoscope, 273 

Griffith's anesthetizing, 137 
Stitch-abscess, 163 
Stomach-contents, examination 

of, 179 
Stone-searcher, Keye's, 127 
Stramonium, poisoning by, 194 
Streptococci, 23, 24 
Streptococcus antitoxin, 42 
preparation of, 39 

lanceolatus, 36 

pyogenes, 35 

staining of, Gram's method, 24 
Stretcher, house-, 88 

improvised, 252 

wheeled, 87 
Strychnin poisoning, 196 
Stump, recurrent bandage of, 80 
Stupe, turpentine, 188 
Sulphur dioxid, 49 
Sulphuric acid as disinfectant, 62 
Surgeon and assistants, prepara- 
tions of, 207 
Surgeon's kit, 99 
contents of, 99 
packing of, 99 
Surgery, antiseptic. Lister's sys- 
tem, 12, 13 
Surgical dressings, 147 

technic, 66 
Sutures, 157 

button, 162 

catgut, 157. See also Catgut. 

continuous, 162 

horsehair, 162 

infection of, 163 

interrupted, 162 

kangaroo-tendon, 157 

shotted, 162 

silk, 161 

silkworm-gut, 158 

silver wire, 162 
Suturing clamps, metal, 162 
Sweating, method of producing, 

188 
Sylvester's method of artificial 

respiration, 231 
Syringe, bulb-, 250 

cup, 240 



3IO 



INDEX. 



Syringe, ear, 240 
fountain-, 250 
Luer's hypodermic, 131 
nasal, 240 



TABI.E-BED, operating, 261 
Tamarind water, 266 
Tampons, 151 

vaginal, 150 
Tapioca jelly, 268 

pudding, 270 

soup, 268 
T-bandage, 83 
Tea, flaxseed, 267 
Temperature, 193 

in death, 274 
Tenaculum, curved, 105 
Tents, 151 
Test-breakfast, 179 
Tetanus antitoxin, 42 

bacillus of, 36 
discovery of, 1 7 
Tetrads, 23 

Theory of antitoxins, 37 
Thermocautery, Paquelin's, 152 
Thermometer, bath-, 180 

clinical, 192 
Thiersch's solution, 59 
Thirst after operations, 220 
Thorax, operations on, 241 
Throat, operations on, 239 

instruments for, 117 
Thumb, bandage of, 72 
Thymol iodid, 57 
Toast, milk, 269 

soup, 267 

water, 267 
Tobacco poisoning, 196 
Tonsillotome, 120 
Tourniquet, Esmarch's, 232 
Tracheal tube, 121 
Trachelorrhaphy, curved scis- 
sors for, 107 

instruments for, 104 
Tracheotomy forceps, 1 2 1 
Transportation of patient, 212 
Traumatic delirium from shock, 

232 
Trays, instrument, 93. See also 

Instrument trays. 



Trays, ligature-, Robb's aseptic, 

94 
Trendelenburg's position, 261 

in bed, 248 
Trephine, DeVilbiss, 124 
Tuberculin, 18 
Tuberculosis, antitoxin of, 43 
preparation of, 39 
bacillus of, 36 
discovery of, 17 
Tubes, drainage-, 168. See also 

Drainage-tubes . 
Tuffier's angiotribe, 11 1 
Tumors, malignant, parasites as 
cause of, 20 
or cysts, instruments for, 114 
treatment of, by Coley's anti- 
toxin mixture, 42 
Turpentine stupe, 188 
Tympanites, 236 
enema for, 184 
Typhoid fever, discovery of ba- 
cilli of, 16 



Upright position, 255 

Ureter-cystoscope, Bremer's, 122 

Urethra, operations on, instru- 
ments for, 126 

Uterus, curetting of, instruments 
for, 108 



Vaccination, 32, 189 

stylet, Mareschal's, 189 
Vacuum treatment apparatus. 

Bier's, for boils, 175 
Vaginal canal, preparation of, for 
operation, 214 

douche, apparatus for, 181 

hysterectomy, 238 
instruments for, 114 

retractor, Schroeder's, 109 

tampon, 150 
Velpeau bandage, 74 
Vinegar, sterilized, as antiseptic, 

63 
Volsella, 105 
Vomiting after etherization, 139 

during anesthetization, 137 



INDEX. 



311 



Walcher posture, 258 
Water, 265 

albumin, 265 

apple, 265 

barley, 266 

coil, 174 

lime, 265 

tamarind, 266 

toast, 267 
Wheeled stretcher, 87 
Wire loop for extraction of lens, 

123 



Wound, irrigation of, apparatus 
for, 156 

Yellow fever, bacillus of, dis- 
covery of, 18 
mosquitoes as disseminators 
of, 18 

Zinc chlorid, 62 

salts, poisoning by, 196 
Zooglea, 23 



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and Throat Nursing just ready 

This is a practical book, prepared by surgeons who, from their 
experience in the operating amphitheatre and at the bedside, 
have realized the shortcomings of present nursing books in 
regard to eye, ear, nose, and throat nursing. 

Nursing in Diseases of the Eye, Ear, Nose and Throat. By the 
Committee on Nurses of the Manhattan Eye, Ear, and Throat Hospital: 
J. Edward Giles, M. D., Surgeon in Eye Department; Arthur B. 
Duel, M. D., (chairman), Surgeon in Ear Department; Harmon 
Smith, M. D., Surgeon in Throat Department. Assisted by John R. 
Shannon, M. D., Assistant Surgeon in Eye Department; and John 
R. Page, M. D., Assistant Surgeon in Ear Department. Witli chap- 
ters by Herbert B. Wilcox, M. D., Attending Physician to the Hos- 
pital ; and Miis Eugenia D. Ayers, Superintendent of Nurses. lamo 
of 300 pages, illustrated. 

Friedenwald and Ruhrah's Dietetics 
for iN urses new (2d) edition 

This work has been prepared to meet the needs of the nurse, 
both in training school and after graduation. American Jour- 
nal of Nursing says it "is exactly the book for which nurses 
and others have long and vainly sought." 

Dietetics for Nurses. By Julius Friedenwald, M. D., Professor 
of Diseases of the Stomach, and JOHN RuhRAH, M. D., Professor of 
Diseases of Children, College of Physicians and Surgeons, Baltimore. 
i2mo volume of 395 pages. Cloth, $1.50 net 



NEW (6th) EDITION 



American Pocket Dictionary 

The Trained Nurse and Hospital Review says: " We have had 
many occasions to refer to this dictionary, and in every instance 
we have found the desired information." 

Dorland's Pocket Medical Dictionary. Edited by W. A. Newman 
DORLAND, M.D., of the University of Pennsylvania. Flexible leather, 
with gold edges, $1.00 net; with patent thumb index, $1.25 net. 



Grafstrom's Mechano-therapy 



SECOND 
EDITION 

Mechano-therapy (Massage and Medical Gymnastics). By Axel V. 
Grafstrom, B. Sc, M. D., Attending Physician, Gustavus Adolphus 
Orphanage, Jamestown, N. Y. i2mo, 200 pages. Cloth, $1.25 net. 



Friedenwald & Ruhrah on Diet 



THIRD EDITION 



Diet in Health and Disease. By JULIUS FRIEDENWALD, M. D., and 
John Ruhrah, M. D. Octavo volume of 764 pages. Cloth, $4.00 net. 



McCombs' Diseases of Children for Nurses 

Dr. McCombs' experience in lecturing to nurses has enabled 
him to emphasize jus^ those points that fiurses most need to know. 
National Hospital Record says: "We have needed a good 
book on children's diseases and this volume admirably fills 
the want." The nurse's side has been written by head 
nurses, very valuable being the work of Miss Jennie Manly. 

Diseases of Children for Nurses. By Robert S. McCombs, M. D., 
Instructor of Nurses at the Children's Hospital of Philadelphia. i2ino 
of 431 pages, illustrated. Cloth. $2.00 net 

Wilson's Obstetric Nursing 

In Dr. Wilson's work the entire subject is covered from the 
beginning of pregnancy, its course, signs, labor, its actual 
accomplishment, the puerperium and care of the infant. 
American Journal of Obstetrics says: " Every page empasizes 
the nurse's relation to the case." 

A Reference Handbook of Obstetric Nursing. By W. Reynolds 
Wilson, M.D., Visiting Physician to the Philadelphia Lying-in Char- 
ity. 3zmo of 355 pages, illustrated. Flexible leather, $1.25 net. 

Morris' Materia Medica new (7.h) edition 

The Trained Nurse and Hospital Review says: *'The work is 
thoroughly up to date, well arranged, compact, and yet con- 
tains a very large amount of matter." 

Essentials of Materia Medica, Therapeutics, and Prescription Writing. 
By Henry Morris, M. D. Revis3d by W. A. BASxtoo, M. D., 
Instructor in Materia Medica and Pharmacology at the Colum- 
bia University, New York. i2mo of 300 pages. Cloth, $1.00 net. 

Griffith's Care of the Baby new (4th) edition 

The New York Medical Journal says: "We are confident if 
this little work could find its way into the hands of every 
trained nurse, infant mortality would be lessened by at least 
fifty per cent." 

The Care of the Baby. By J. P. Crozer Griffith, M. D., Clinical 
Professor of Diseases of Children, University of Pennsylvania. 
i2mo of 455 pages, illustrated, including 5 plates. Cloth, $1.50 net 



Lewis' Anatomy and Physiology 

RECENTLY ISSUED— THE NEW (2d) EDITION 

Nurses Journal of Pacific Co<2s/ says ''it is not in any sense rud- 
imentary, but comprehensive in its treatment of the subjects." 

Anatomy and Physiology for Nurses. By LeRoy LEWIS, M.D., Lec- 
turer on Anatomy and Physiology tor Nurses, Lewis Hospital, Bay 
City, Mich. i2mo of 375 pages, 15c illustrations. Cloth, $1.75 net. 

Borland's Illustrated Dictionary 

THE NEW (5th) EDITION— 2000 NEW TERMS 

This edition contains over 2000 new terms. Dr, Howard A. 
Kelly says: ** Dr. Borland's Dictionary is admirable. It is so 
well gotten up and of such convenient size. No errors have 
been found in my use of it." 

The American Illustrated Medical Dictionary. A Dictionary of the 
terms used in Medicine. Surgery, Dentistry, Pharmacy. Chemistry, 
and kindred branches; with loo new and elaborate tables By W. 
A. N. DORLAND, M. D. Large octavo of 876 pages, 2g3 illustrations, 
iiq in colors. Flexible leather, $4.50 net: thumb index, $5.00 net 

Morrow's Immediate Care of Injured 

The Trained Nurse and Hospital Review says: '* We are most 
pleased with the work. The illustrations are clear and prac- 
tical; the wording plain and reasonably concise." It is an 
invaluable work for the nurse — practical in the extreme. 

Immediate Care of the Injured. By Albert S. Morrow, M. D., 
Attending Surgeon to the New York City Home for the Aged and 
Infirm. Octavo of 340 pages, with 238 illustrations. Cloth, $2.50 net. 

Register's Fever Nursing 

A Text- Book on Practical Fever Nursing. By Edward 
C. RkGisTkr, M.D., Professor of the Practice of Medi- 
cine in the North Carolina Medical College. Octavo 
of 350 pages, illustrated. • Cloth, |2.50 net. 



Pyle's Personal Hygiene 



NEW (3d) EDITION 



A Manual of Personal Hygiene. Edited by Wai^ter 
I,. Pyi,k, M.D., Wills Eye Hospital, Philadelphia. 
Octavo, 451 pages, Illustrated. $1.50 net. 



OCT ^ W 



One copy del. to Cat. Div. 



0^ s s$r 



LIBRARY OF CONGRESS 



021 062 375 5 



